1
|
Thomas C, Heathcote L, Sun Y, Callister MEJ, Kitt J, Rossi SH, Shinkins B, Usher-Smith JA, Whyte S, Stewart GD. Cost-effectiveness of one-off upper abdominal CT screening as an add-on to lung cancer screening in England. Br J Cancer 2025:10.1038/s41416-025-03043-z. [PMID: 40369122 DOI: 10.1038/s41416-025-03043-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2024] [Revised: 04/14/2025] [Accepted: 04/24/2025] [Indexed: 05/16/2025] Open
Abstract
BACKGROUND Low-dose computed tomography (CT) screening for lung cancer is available for high-risk individuals in England. Screening simultaneously for upper abdominal conditions, including cancer, is feasible. Here, we estimate the cost-effectiveness of one-off upper abdominal CT screening, added onto lung cancer screening, based on the Yorkshire Kidney Screening Trial (YKST) feasibility study. METHODS A multi-disease health economic model was developed. Ten cancers and abdominal aortic aneurysm (AAA) were modelled over a lifetime horizon. YKST data informed disease prevalence, resource use and screening costs. Costs, quality-adjusted life-years (QALYs) and cost-effectiveness were estimated probabilistically. RESULTS Screening per person costs £70.89, produces 0.0059 QALYs, and has 96% probability of being cost-effective, with an incremental cost-effectiveness ratio of £12,085. AAA contributes most to cost-effectiveness, followed by kidney cancer, but some cancer findings reduce cost-effectiveness. Screening is more cost-effective at younger ages. Screen-detectable disease prevalence, severity and mortality risk contribute most to uncertainty. CONCLUSIONS One-off upper abdominal CT screening is potentially cost-effective, but costs, harms and benefits vary between conditions. Cost-effectiveness is driven by early diagnosis of AAA, then kidney cancer, illustrating the importance of considering all relevant diseases in screening models. A larger trial would provide more robust data to refine the cost-effectiveness argument. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov: NCT05005195.
Collapse
Affiliation(s)
- Chloe Thomas
- Sheffield Centre for Health and Related Research (SCHARR), School of Medicine and Population Health, University of Sheffield, Sheffield, UK.
| | - Laura Heathcote
- Sheffield Centre for Health and Related Research (SCHARR), School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | - Yuxiao Sun
- Sheffield Centre for Health and Related Research (SCHARR), School of Medicine and Population Health, University of Sheffield, Sheffield, UK
- London School of Hygiene and Tropical Medicine, London, UK
| | - Matthew E J Callister
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
- Department of Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Jessica Kitt
- Department of Surgery, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK
| | - Sabrina H Rossi
- Department of Surgery, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK
- CRUK Cambridge Centre, Cambridge Biomedical Campus, Cambridge, UK
| | - Bethany Shinkins
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Juliet A Usher-Smith
- CRUK Cambridge Centre, Cambridge Biomedical Campus, Cambridge, UK
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Sophie Whyte
- Sheffield Centre for Health and Related Research (SCHARR), School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | - Grant D Stewart
- Department of Surgery, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK
- CRUK Cambridge Centre, Cambridge Biomedical Campus, Cambridge, UK
| |
Collapse
|
2
|
Zong NC, Huang K, Yang X, Cai H. Expand the success of screening to reduce aortic aneurysm mortality: progress interpretation and new fronts. Trends Cardiovasc Med 2025; 35:221-229. [PMID: 39675687 DOI: 10.1016/j.tcm.2024.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 12/04/2024] [Accepted: 12/04/2024] [Indexed: 12/17/2024]
Abstract
Aortic aneurysm is a leading cause of death across the world. Many victicms carry it without knowing. Ruputre of aortic aneurysms leads to devastating sudden death. This brings trauma to families and our society. Based upon sound results out of several cohort studies, US Preventive Services Task Force (USPST) crafted the 1st nationwide abdominal aorta aneurysm (AAA) screening program in 2005. It was renewed and expanded in subsequent revisions in 2014 and 2019. UK and Sweden estalished their own programs as well. Since then, a significant decline in AAA prevalence and mortality has been observed. Two decades into the practice, the state of the art on diagnostics, surgical approaches, and pharmacological options have drastically changed. Patients previously ineligible for treatment or inconclusive on diagnostics now have valid options. The screening program is on the verge for a bold expansion. In this review, we summarize the chroncles leading to the inception of the screening programs, progress in interpretation after implementation including gains, gaps and controversies, advents of new technologies and approaches, new fronts facing us, as well as priorities to be addressed in future phases. Particularly, screening asssys with a clinically tested biomarker, tetrahydrobiopterin (H4B), enables unpresended accessibility, consistency and throughput to accommodate the needs of a larger population. Furthermore, patients with AAAs at size below the eligibility threhold for surgical intervention (e.g., < 5.5 cm) can be treated with novel oral medications. Confronting factors such as changing demographics and COVID-19 aftermath are putting up new challenges. Nevertheless, running a program at national scale demands both unwavering commitment and agile fine-tuning. Technical innovation will be an indispensable chapter of its continued success. The burden of aortic aneurysm-led sudden death is too heavy for any family and the society to bear; it is time to step up our resolve with additional capacities as discussed in the present review.
Collapse
Affiliation(s)
- Nobel Chenggong Zong
- Division of Molecular Medicine, Department of Anesthesiology and Perioperative Medicine, Division of Cardiology, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Kai Huang
- Division of Molecular Medicine, Department of Anesthesiology and Perioperative Medicine, Division of Cardiology, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Xia Yang
- Department of Integrative Biology and Physiology, College of Life Science, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Hua Cai
- Division of Molecular Medicine, Department of Anesthesiology and Perioperative Medicine, Division of Cardiology, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, 90095, USA.
| |
Collapse
|
3
|
Earnshaw JJ, Mitra S, Strachan H, Gardner P. Abdominal aortic aneurysm screening: current effectiveness and future perspectives. Br J Surg 2025; 112:znaf094. [PMID: 40328447 DOI: 10.1093/bjs/znaf094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2025] [Accepted: 04/03/2025] [Indexed: 05/08/2025]
Affiliation(s)
- Jonothan J Earnshaw
- Formerly Gloucestershire Hospitals NHS Foundation Trust, Gloucestershire GL2 8DT, UK
| | - Sophie Mitra
- Department of Health and Social Care, 39 Victoria Street, London SW1H 0EU, UK
| | - Harriet Strachan
- Department of Health and Social Care, 39 Victoria Street, London SW1H 0EU, UK
| | - Philip Gardner
- Department of Health and Social Care, 39 Victoria Street, London SW1H 0EU, UK
| |
Collapse
|
4
|
Aljabban I, Sansosti A, Wang P, Camacho GA, Zhang M, Bajakian D, Morrissey N, Kurlansky P, Patel V, O'Donnell TFX. Prevalence of aortoiliac aneurysms in solid organ transplant recipients using the National Inpatient Sample database. J Vasc Surg 2025; 81:887-893.e3. [PMID: 39716579 DOI: 10.1016/j.jvs.2024.12.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2024] [Revised: 12/06/2024] [Accepted: 12/15/2024] [Indexed: 12/25/2024]
Abstract
OBJECTIVE Single-center studies have suggested that solid organ transplant recipients are at increased risk for arterial aneurysms. Moreover, they describe a more aggressive natural history with increased rates of expansion and rupture. In this exploratory analysis, we aimed to assess the frequency of arterial aneurysms in solid organ transplant recipients using a large-scale national database. METHODS We queried the National Inpatient Sample dataset from 2016 to 2020 using International Classification of Disease, Tenth Revision, Clinical Modification codes to identify patients with solid organ transplants. We calculated the prevalence of aortoiliac aneurysms by organ transplant type and performed one:one propensity score matching to compare aneurysm rates between transplant recipients and nontransplant patients. Additionally, we used a multivariable model to determine whether the observed aneurysm frequency was due to the transplant intervention or attributable to variable baseline characteristics of the groups. RESULTS A retrospective analysis of the National Inpatient Sample database identified 34,920,964 nontransplant patients and 34,288 transplant recipients. Among the transplant cohort, kidney transplant recipients made up the largest group at 57.5%. The median age of the transplant group was 55 years, with a predominance of male patients and a low smoking rate of 2.19%. The overall frequency of aortoiliac aneurysms in the transplant population was 0.48%. Specifically, the prevalence of thoracic aortic aneurysms, abdominal aortic aneurysms, and iliac artery aneurysms was 0.2%, 0.19%, and 0.06%, respectively. Thoracic organ transplant recipients had a higher frequency of aortoiliac aneurysms compared with those with abdominal organ transplants. The frequencies of aortoiliac aneurysms were 0.81% in heart transplant recipients, 1.37% in single lung recipients, 0.91% in double lung recipients, 0.42% in liver recipients, and 0.42% in kidney recipients. Additionally, the frequency of abdominal aortic aneurysms was 0.42% in heart transplant recipients and 0.51% in single lung transplant recipients. CONCLUSIONS As transplant patient survival continues to improve, monitoring for comorbid conditions will become increasingly important. Given the limited availability of organs and importance of post-transplant care, the observed prevalence of aortoiliac aneurysms in heart, lung, and liver transplant recipients highlights the need for enhanced screening and surveillance. Further studies are required to better understand the rates of aneurysm expansion and rupture in solid organ transplant recipients.
Collapse
Affiliation(s)
- Imad Aljabban
- Division of Vascular Surgery and Endovascular Interventions, Columbia University Irving Medical Center, New York, NY
| | - Alexandra Sansosti
- Division of Vascular Surgery and Endovascular Interventions, Columbia University Irving Medical Center, New York, NY
| | - Pengchen Wang
- Center for Innovation and Outcomes Research, Columbia University Irving Medical Center, New York, NY
| | - Gabriella A Camacho
- Division of Vascular Surgery and Endovascular Interventions, Columbia University Irving Medical Center, New York, NY
| | - Michelle Zhang
- Division of Vascular Surgery and Endovascular Interventions, Columbia University Irving Medical Center, New York, NY
| | - Danielle Bajakian
- Division of Vascular Surgery and Endovascular Interventions, Columbia University Irving Medical Center, New York, NY
| | - Nicholas Morrissey
- Division of Vascular Surgery and Endovascular Interventions, Columbia University Irving Medical Center, New York, NY
| | - Paul Kurlansky
- Center for Innovation and Outcomes Research, Columbia University Irving Medical Center, New York, NY
| | - Virendra Patel
- Division of Vascular Surgery and Endovascular Interventions, Columbia University Irving Medical Center, New York, NY
| | - Thomas F X O'Donnell
- Division of Vascular Surgery and Endovascular Interventions, Columbia University Irving Medical Center, New York, NY.
| |
Collapse
|
5
|
Sidik AI, Al-Ariki MK, Shafii AI, Hossain ML, Najneen F, Ak G, Ahlam D, Shakiba A, Ghosh D, Ajgar Bithi MA, Kairatuly MI. Advances in Imaging and Diagnosis of Abdominal Aortic Aneurysm: A Shift in Clinical Practice. Cureus 2025; 17:e81321. [PMID: 40291317 PMCID: PMC12033972 DOI: 10.7759/cureus.81321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2025] [Indexed: 04/30/2025] Open
Abstract
Abdominal aortic aneurysm (AAA) is a potentially life-threatening vascular condition, with rupture carrying a high mortality risk. Advances in imaging technologies have significantly improved the detection, risk stratification, and management of AAA, necessitating periodic updates to international clinical guidelines. This review examines recent advancements in AAA imaging modalities, their role in diagnosis and risk assessment, and evolving screening strategies in response to changing epidemiological trends. A systematic literature search was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, identifying key studies on diagnostic imaging techniques such as ultrasonography (US), computed tomography angiography (CTA), magnetic resonance angiography (MRA), intravascular US (IVUS), positron emission tomography-computed tomography (PET-CT), and artificial intelligence (AI)-driven imaging. US remains the preferred screening tool due to its cost-effectiveness, while CTA is the gold standard for preoperative planning. MRA is an alternative for patients with renal impairment, and emerging technologies such as AI-based imaging, IVUS, and PET-CT enhance risk prediction and surgical decision-making. Declining AAA prevalence, attributed to reduced smoking rates and improved cardiovascular risk management, has led to a shift from population-wide screening to targeted screening based on individual risk factors. Additionally, the standardization of imaging protocols and caliper placement techniques is crucial for accurate measurements and consistent clinical decision-making. As imaging technology continues to evolve, integrating AI, genetic markers, and biomarkers into screening and diagnostic protocols may enable more precise and personalized AAA management. Future research should focus on refining imaging-based risk stratification models to optimize screening and treatment strategies.
Collapse
Affiliation(s)
- Abubakar I Sidik
- Cardiovascular Surgery, Peoples' Friendship University of Russia, Moscow, RUS
| | - Malik K Al-Ariki
- Cardiothoracic Surgery, Peoples' Friendship University of Russia, Moscow, RUS
| | | | | | - Farjana Najneen
- Cardiovascular Medicine, Peoples' Friendship University of Russia, Moscow, RUS
| | - Gulten Ak
- Cardiovascular Medicine, Peoples' Friendship University of Russia, Moscow, RUS
| | - Derrar Ahlam
- Cardiovascular Medicine, Peoples' Friendship University of Russia, Moscow, RUS
| | - Abdoli Shakiba
- Cardiovascular Medicine, Peoples' Friendship University of Russia, Moscow, RUS
| | - Debraj Ghosh
- Cardiovascular Medicine, Peoples' Friendship University of Russia, Moscow, RUS
| | | | | |
Collapse
|
6
|
Thorbjørnsen K, Lyttkens L, Mani K, Wanhainen A, Svensjö S. Change in Quality Adjusted Life Years in 65 Year Old Men Screened for Abdominal Aortic Aneurysm: A Longitudinal Case Control Study. Eur J Vasc Endovasc Surg 2025:S1078-5884(25)00145-5. [PMID: 39956266 DOI: 10.1016/j.ejvs.2025.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2024] [Revised: 01/20/2025] [Accepted: 02/10/2025] [Indexed: 02/18/2025]
Affiliation(s)
- Knut Thorbjørnsen
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden; Centre for Research and Development, Uppsala University, Region Gävleborg, Sweden; Department of Surgery, Gävle County Hospital, Gävle, Sweden.
| | - Linda Lyttkens
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden
| | - Kevin Mani
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden
| | - Anders Wanhainen
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden; Department of Surgical and Peri-operative Sciences, Surgery, Umeå, Sweden
| | - Sverker Svensjö
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden; Centre for Clinical Research, Uppsala University, Region Dalarna, Sweden; Department of Surgery, Falun County Hospital, Falun, Sweden
| |
Collapse
|
7
|
Abbas GH, Khouri E, Pouwels S. Artificial Intelligence-Based Predictive Modeling for Aortic Aneurysms. Cureus 2025; 17:e79662. [PMID: 40161150 PMCID: PMC11950341 DOI: 10.7759/cureus.79662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2025] [Indexed: 04/02/2025] Open
Abstract
Abdominal aortic aneurysms (AAAs) remain a major concern to the global society because of the associated risk of rupture and death. Currently, the management of AAAs entails clinical and imaging risk factors, which are not precise and accurate in terms of patient-specific risk assessment. Over the last decade, the utilization of artificial intelligence (AI) and machine learning (ML) algorithms has transformed the process of decision-making in the field of medicine by allowing for the creation of personalized models based on the patient's characteristics. This review aims to discuss the current state and future directions of AI in the form of predictive modeling for aortic aneurysms, stressing the versatility and progression of the ML approaches in risk assessment, screening, and prognosis. We expand on the various strategies used in AI-based solutions and the differences between general and specific approaches such as supervised and unsupervised learning, deep learning, and others. Furthermore, we bring forward the problem of incorporating clinical, imaging, and genomic data into AI/ML to improve its predictiveness and applicability to clinical practice. In addition, we discuss the difficulties and prospects of turning the developed AI-based forecasting models into clinical practice, as well as the problems associated with data quality, model explainability, and legal and ethical concerns. This review aims to reveal the opportunities of AI and ML in enhancing the risk assessment and management of AAAs to shift the paradigm of cardiovascular care toward precision medicine.
Collapse
Affiliation(s)
- Ghulam Husain Abbas
- Faculty of Medicine, Ala-Too International University, Bishkek, KGZ
- Department of Medicine, Mass General Brigham, Boston, USA
| | - Edmon Khouri
- Faculty of Medicine, University of Jordan, Amman, JOR
| | - Sjaak Pouwels
- Department of Surgery, Bielefeld University - Detmold Campus, Detmold, DEU
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, NLD
| |
Collapse
|
8
|
Withers TM, Greaves CJ, Bown MJ, Ashton F, Scott AJ, Hollings VE, Elsworth AM, Saratzis A. A feasibility study of the CRISP intervention; a cardiovascular risk reduction intervention in patients with an abdominal aortic aneurysm. NIHR OPEN RESEARCH 2024; 4:34. [PMID: 39429721 PMCID: PMC11489837 DOI: 10.3310/nihropenres.13596.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/29/2024] [Indexed: 10/22/2024]
Abstract
Background Abdominal aortic aneurysm (AAA) screening/surveillance is implemented widely. Those in AAA-surveillance are at high-risk of cardiovascular-events. We developed an intervention, called CRISP, using intervention-mapping, to reduce cardiovascular-risk in AAA-surveillance. This study tested the CRISP intervention in routine clinical-care. Methods The CRISP intervention, consisting of a nurse-led cardiovascular risk assessment and subsequent lifestyle change support using a self-care workbook and low-intensity nurse input was delivered in two screening/surveillance programmes. Those consenting to take part were followed-up with cardiovascular-assessments. Fidelity of intervention-delivery was assessed quantitatively/qualitatively. Results 40 men (mean age 75 ± 7 years) took part over four months and followed-up for a minimum six months. A sub-group of 25 patients and nine Health Care Professionals (HCPs) were interviewed. The median number of risk-factors that patients chose to focus on was two (range 0 to 4), with physical activity (n=17) being the most popular. Participants who had a 'red light' risk factor for stress, low mood, smoking or alcohol intake were offered a referral to appropriate services. Two were offered referral to mental-health services and took it up, three declined referrals to smoking or alcohol support services. The fidelity of intervention-delivery (a score intervention components delivered to each patient based on a score from 0 to 5, with 5 being highest delivery fidelity) was generally low. The highest mean score (on a 0-5 scale) for the nurse assessment was 1.5 for engaging the participant, lowest 0.5 for exploring the importance for selected lifestyle behaviours. In qualitative interviews, the intervention was liked by patients/HCPs. Based on qualitative interviews and observations, the low fidelity of intervention-delivery was due to intervention-training not being detailed. Conclusions CRISP can be delivered in AAA-surveillance, but fidelity of delivery is low. The intervention and its training need to be refined/tested before wider implementation. Registration ISRCTN9399399518/11/20).
Collapse
Affiliation(s)
- Tom M. Withers
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, England, UK
| | - Colin J. Greaves
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, England, UK
| | - Matt J. Bown
- Department of Cardiovascular Sciences & NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, England, UK
| | - Faye Ashton
- Department of Cardiovascular Sciences & NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, England, UK
| | - Aimee J. Scott
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, England, UK
| | - Vanessa E. Hollings
- Department of Cardiovascular Sciences & NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, England, UK
| | - Ann M. Elsworth
- Department of Cardiovascular Sciences & NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, England, UK
| | - Athanasios Saratzis
- Department of Cardiovascular Sciences & NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, England, UK
| |
Collapse
|
9
|
Summers KL, Kerut EK, To F, Sheahan CM, Sheahan MG. Machine learning-based prediction of abdominal aortic aneurysms for individualized patient care. J Vasc Surg 2024; 79:1057-1067.e2. [PMID: 38185212 DOI: 10.1016/j.jvs.2023.12.046] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 11/30/2023] [Accepted: 12/01/2023] [Indexed: 01/09/2024]
Abstract
OBJECTIVE The United States Preventative Services Task Force guidelines for screening for abdominal aortic aneurysms (AAA) are broad and exclude many at risk groups. We analyzed a large AAA screening database to examine the utility of a novel machine learning (ML) model for predicting individual risk of AAA. METHODS We created a ML model to predict the presence of AAAs (>3 cm) from the database of a national nonprofit screening organization (AAAneurysm Outreach). Participants self-reported demographics and comorbidities. The model is a two-layered feed-forward shallow network. The ML model then generated AAA probability based on patient characteristics. We evaluated graphs to determine significant factors, and then compared those graphs with a traditional logistic regression model. RESULTS We analyzed a cohort of 10,033 patients with an AAA prevalence of 2.74%. Consistent with logistic regression analysis, the ML model identified the following predictors of AAA: Caucasian race, male gender, advancing age, and recent or past smoker with recent smoker having a more profound affect (P < .05). Interestingly, the ML model showed body mass index (BMI) was associated with likelihood of AAAs, especially for younger females. The ML model also identified a higher than predicted risk of AAA in several groups, including female nonsmokers with cardiac disease, female diabetics, those with a family history of AAA, and those with hypertension or hyperlipidemia at older ages. An elevated BMI conveyed a higher than expected risk in male smokers and all females. The ML model also identified a complex relationship of both diabetes mellitus and hyperlipidemia with gender. Family history of AAA was a more important risk factor in the ML model for both men and women too. CONCLUSIONS We successfully developed an ML model based on an AAA screening database that unveils a complex relationship between AAA prevalence and many risk factors, including BMI. The model also highlights the need to expand AAA screening efforts in women. Using ML models in the clinical setting has the potential to deliver precise, individualized screening recommendations.
Collapse
Affiliation(s)
- Kelli L Summers
- Division of Vascular Surgery, Department of Surgery, LSU Health Sciences Center, School of Medicine, New Orleans, LA.
| | - Edmund K Kerut
- Division of Cardiovascular Diseases, Department of Medicine, LSU Health Sciences Center, New Orleans, LA; Heart Clinic of Louisiana, Marrero, LA
| | - Filip To
- Department of Agricultural and Biological Engineering, Bagley College of Engineering, Mississippi State University, Mississippi State, MS
| | - Claudie M Sheahan
- Division of Vascular Surgery, Department of Surgery, LSU Health Sciences Center, School of Medicine, New Orleans, LA
| | - Malachi G Sheahan
- Division of Vascular Surgery, Department of Surgery, LSU Health Sciences Center, School of Medicine, New Orleans, LA
| |
Collapse
|
10
|
Vervoort D, Hirode G, Lindsay TF, Tam DY, Kapila V, de Mestral C. One-time screening for abdominal aortic aneurysm in Ontario, Canada: a model-based cost-utility analysis. CMAJ 2024; 196:E112-E120. [PMID: 38316457 PMCID: PMC10843437 DOI: 10.1503/cmaj.230913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2023] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Screening programs for abdominal aortic aneurysm (AAA) are not available in Canada. We sought to determine the effectiveness and costutility of AAA screening in Ontario. METHODS We compared one-time ultrasonography-based AAA screening for people aged 65 years to no screening using a fully probabilistic Markov model with a lifetime horizon. We estimated life-years, quality-adjusted life-years (QALYs), AAA-related deaths, number needed to screen to prevent 1 AAA-related death and costs (in Canadian dollars) from the perspective of the Ontario Ministry of Health. We retrieved model inputs from literature, Statistics Canada, and the Ontario Case Costing Initiative. RESULTS Screening reduced AAA-related deaths by 84.9% among males and 81.0% among females. Compared with no screening, screening resulted in 0.04 (18.96 v. 18.92) additional life-years and 0.04 (14.95 v. 14.91) additional QALYs at an incremental cost of $80 per person among males. Among females, screening resulted in 0.02 (21.25 v. 21.23) additional life-years and 0.01 (16.20 v. 16.19) additional QALYs at an incremental cost of $11 per person. At a willingness-to-pay of $50 000 per year, screening was cost-effective in 84% (males) and 90% (females) of model iterations. Screening was increasingly cost-effective with higher AAA prevalence. INTERPRETATION Screening for AAA among people aged 65 years in Ontario was associated with fewer AAA-related deaths and favourable cost-effectiveness. To maximize QALY gains per dollar spent and AAA-related deaths prevented, AAA screening programs should be designed to ensure that populations with high prevalence of AAA participate.
Collapse
Affiliation(s)
- Dominique Vervoort
- Institute of Health Policy, Management and Evaluation (Vervoort, Tam, de Mestral), Division of Cardiac Surgery (Vervoort, Tam) and Institute of Medical Science (Hirode), University of Toronto; Toronto Centre for Liver Disease (Hirode), Toronto General Hospital, University Health Network; Division of Vascular Surgery, Department of Surgery (Lindsay), Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ont.; Division of Vascular Surgery (Kapila), William Osler Health System, Brampton, Ont.; Division of Vascular Surgery, Department of Surgery (de Mestral), St. Michael's Hospital, University of Toronto, Toronto, Ont
| | - Grishma Hirode
- Institute of Health Policy, Management and Evaluation (Vervoort, Tam, de Mestral), Division of Cardiac Surgery (Vervoort, Tam) and Institute of Medical Science (Hirode), University of Toronto; Toronto Centre for Liver Disease (Hirode), Toronto General Hospital, University Health Network; Division of Vascular Surgery, Department of Surgery (Lindsay), Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ont.; Division of Vascular Surgery (Kapila), William Osler Health System, Brampton, Ont.; Division of Vascular Surgery, Department of Surgery (de Mestral), St. Michael's Hospital, University of Toronto, Toronto, Ont
| | - Thomas F Lindsay
- Institute of Health Policy, Management and Evaluation (Vervoort, Tam, de Mestral), Division of Cardiac Surgery (Vervoort, Tam) and Institute of Medical Science (Hirode), University of Toronto; Toronto Centre for Liver Disease (Hirode), Toronto General Hospital, University Health Network; Division of Vascular Surgery, Department of Surgery (Lindsay), Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ont.; Division of Vascular Surgery (Kapila), William Osler Health System, Brampton, Ont.; Division of Vascular Surgery, Department of Surgery (de Mestral), St. Michael's Hospital, University of Toronto, Toronto, Ont
| | - Derrick Y Tam
- Institute of Health Policy, Management and Evaluation (Vervoort, Tam, de Mestral), Division of Cardiac Surgery (Vervoort, Tam) and Institute of Medical Science (Hirode), University of Toronto; Toronto Centre for Liver Disease (Hirode), Toronto General Hospital, University Health Network; Division of Vascular Surgery, Department of Surgery (Lindsay), Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ont.; Division of Vascular Surgery (Kapila), William Osler Health System, Brampton, Ont.; Division of Vascular Surgery, Department of Surgery (de Mestral), St. Michael's Hospital, University of Toronto, Toronto, Ont
| | - Varun Kapila
- Institute of Health Policy, Management and Evaluation (Vervoort, Tam, de Mestral), Division of Cardiac Surgery (Vervoort, Tam) and Institute of Medical Science (Hirode), University of Toronto; Toronto Centre for Liver Disease (Hirode), Toronto General Hospital, University Health Network; Division of Vascular Surgery, Department of Surgery (Lindsay), Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ont.; Division of Vascular Surgery (Kapila), William Osler Health System, Brampton, Ont.; Division of Vascular Surgery, Department of Surgery (de Mestral), St. Michael's Hospital, University of Toronto, Toronto, Ont
| | - Charles de Mestral
- Institute of Health Policy, Management and Evaluation (Vervoort, Tam, de Mestral), Division of Cardiac Surgery (Vervoort, Tam) and Institute of Medical Science (Hirode), University of Toronto; Toronto Centre for Liver Disease (Hirode), Toronto General Hospital, University Health Network; Division of Vascular Surgery, Department of Surgery (Lindsay), Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ont.; Division of Vascular Surgery (Kapila), William Osler Health System, Brampton, Ont.; Division of Vascular Surgery, Department of Surgery (de Mestral), St. Michael's Hospital, University of Toronto, Toronto, Ont.
| |
Collapse
|
11
|
Wanhainen A, Van Herzeele I, Bastos Goncalves F, Bellmunt Montoya S, Berard X, Boyle JR, D'Oria M, Prendes CF, Karkos CD, Kazimierczak A, Koelemay MJW, Kölbel T, Mani K, Melissano G, Powell JT, Trimarchi S, Tsilimparis N, Antoniou GA, Björck M, Coscas R, Dias NV, Kolh P, Lepidi S, Mees BME, Resch TA, Ricco JB, Tulamo R, Twine CP, Branzan D, Cheng SWK, Dalman RL, Dick F, Golledge J, Haulon S, van Herwaarden JA, Ilic NS, Jawien A, Mastracci TM, Oderich GS, Verzini F, Yeung KK. Editor's Choice -- European Society for Vascular Surgery (ESVS) 2024 Clinical Practice Guidelines on the Management of Abdominal Aorto-Iliac Artery Aneurysms. Eur J Vasc Endovasc Surg 2024; 67:192-331. [PMID: 38307694 DOI: 10.1016/j.ejvs.2023.11.002] [Citation(s) in RCA: 350] [Impact Index Per Article: 350.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 09/20/2023] [Indexed: 02/04/2024]
Abstract
OBJECTIVE The European Society for Vascular Surgery (ESVS) has developed clinical practice guidelines for the care of patients with aneurysms of the abdominal aorta and iliac arteries in succession to the 2011 and 2019 versions, with the aim of assisting physicians and patients in selecting the best management strategy. METHODS The guideline is based on scientific evidence completed with expert opinion on the matter. By summarising and evaluating the best available evidence, recommendations for the evaluation and treatment of patients have been formulated. The recommendations are graded according to a modified European Society of Cardiology grading system, where the strength (class) of each recommendation is graded from I to III and the letters A to C mark the level of evidence. RESULTS A total of 160 recommendations have been issued on the following topics: Service standards, including surgical volume and training; Epidemiology, diagnosis, and screening; Management of patients with small abdominal aortic aneurysm (AAA), including surveillance, cardiovascular risk reduction, and indication for repair; Elective AAA repair, including operative risk assessment, open and endovascular repair, and early complications; Ruptured and symptomatic AAA, including peri-operative management, such as permissive hypotension and use of aortic occlusion balloon, open and endovascular repair, and early complications, such as abdominal compartment syndrome and colonic ischaemia; Long term outcome and follow up after AAA repair, including graft infection, endoleaks and follow up routines; Management of complex AAA, including open and endovascular repair; Management of iliac artery aneurysm, including indication for repair and open and endovascular repair; and Miscellaneous aortic problems, including mycotic, inflammatory, and saccular aortic aneurysm. In addition, Shared decision making is being addressed, with supporting information for patients, and Unresolved issues are discussed. CONCLUSION The ESVS Clinical Practice Guidelines provide the most comprehensive, up to date, and unbiased advice to clinicians and patients on the management of abdominal aorto-iliac artery aneurysms.
Collapse
|
12
|
Withers TM, Greaves CJ, Bown MJ, Saratzis A. Improving cardiovascular health in patients with an abdominal aortic aneurysm: development of the cardiovascular risk reduction in patients with aneurysms (CRISP) behaviour change intervention. Pilot Feasibility Stud 2024; 10:17. [PMID: 38287363 PMCID: PMC10823620 DOI: 10.1186/s40814-024-01445-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 01/12/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Abdominal aortic aneurysm (AAA) is an important cardiovascular health problem. Ultrasound screening is proven to reduce AAA mortality and programmes have been implemented in some healthcare systems. Those who are identified as having a small AAA in screening enter into a surveillance programme to monitor AAA size. Individuals in AAA surveillance are at elevated risk of cardiovascular events, which is not currently addressed sufficiently. We aimed to develop a simple intervention to reduce cardiovascular risk, which could be embedded in AAA surveillance pathways. METHODS Intervention mapping methods were used to co-develop the intervention with individuals with AAA, families/carers, and healthcare staff. We identified "targets for change" by synthesising research evidence and international guidelines and consulting with patients, caregivers and health service providers. We conducted a series of workshops to identify barriers to and facilitators of change and used taxonomies of behaviour change theories and techniques to match intervention strategies to each target. Further stakeholder involvement work helped refine the intervention. RESULTS The developed intervention focusses on assessment and individually tailored discussion of risk factors, exchanging information, building motivation and action planning, followed by review of progress and problem-solving. Workbooks covering physical activity, diet, stress management, alcohol, smoking, blood pressure and mental health are provided to support behaviour change. The intervention is facilitated by trained healthcare professionals during the patient's AAA screening appointment for the duration that they are in surveillance. DISCUSSION The developed intervention will now be tested to assess whether it can be integrated with the current AAA screening programme. The developed intervention is a novel approach to reducing cardiovascular disease in the AAA population, it is also the first intervention which tries to do this in this population. TRIAL REGISTRATION International Clinical Trial Registration: ISRCTN93993995.
Collapse
Affiliation(s)
- Tom M Withers
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Colin J Greaves
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Matt J Bown
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Athanasios Saratzis
- University Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.
| |
Collapse
|
13
|
Fattahi N, Linné A, Roy J, Stenman M, Svensjö S, Nilsson O, Hultgren R. Prevalence of abdominal aortic aneurysm (AAA) in first-degree relatives: detecting AAA in adult offspring of AAA patients. BJS Open 2024; 8:zrad163. [PMID: 38195162 PMCID: PMC10776345 DOI: 10.1093/bjsopen/zrad163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/15/2023] [Accepted: 12/05/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND First-degree relatives of patients with abdominal aortic aneurysm (AAA) may have an increased risk of developing the disease. The primary aim was to report the prevalence of AAA in adult male and female offspring of patients with AAA. The secondary aim was to explore the efficiency of a registry-based detection route, and the third aim was to report contemporary prevalence in the population. METHODS Adult offspring of individuals with AAA and matched controls were identified through national registries. The examination included questionnaires and ultrasound examinations of the infrarenal aorta. Aortic pathology was defined as an aortic diameter ≥25 mm, AAA ≥30 mm. RESULTS The participation rate among male and female adult offspring was 64% (350/543) and 69% (402/583), respectively. A lower participation rate was found in male and female controls (51% and 52%). No difference in prevalence of AAA was observed between male adult offspring and controls (0.9%, c.i. 0.2 to 2.3%) or in the female population (prevalence of 0.2% in adult offspring and controls). Aortic pathology and previously diagnosed AAA were detected in 5.3% (c.i. 3.3 to 8.0%) of male adult offspring and 2.3% (c.i. 1.1 to 4.2%) in controls. Aortic pathology was more prevalent among adult offspring of females with AAA. CONCLUSION The prevalence of AAA in the general population is low, but aortic pathology is notably higher among male first-degree relatives. Increased awareness should be directed towards individuals with a possible hereditary predisposition, particularly offspring of females with AAA and older smokers. Risk factor-based targeted screening of adult offspring of patients with AAA after registry-based detection should be further explored. TRIAL REGISTRATION ClinicalTrials.gov identifier, NCT4623268.
Collapse
Affiliation(s)
- Nina Fattahi
- Department of Clinical Science and Education, Karolinska Institutet at Södersjukhuset, Stockholm, Sweden
- Section of Vascular Surgery, Department of Surgery, Södersjukhuset, Stockholm, Sweden
| | - Anneli Linné
- Department of Clinical Science and Education, Karolinska Institutet at Södersjukhuset, Stockholm, Sweden
- Section of Vascular Surgery, Department of Surgery, Södersjukhuset, Stockholm, Sweden
| | - Joy Roy
- Department of Vascular Surgery, Karolinska University Hospital Stockholm, Stockholm, Sweden
- Stockholm Aneurysm Research Group, STAR, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Malin Stenman
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Perioperative Medicine and Intensive Care Function, Karolinska University Hospital, Stockholm, Sweden
| | - Sverker Svensjö
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Department of Surgery, Falun County Hospital, Falun, Sweden
| | - Olga Nilsson
- Department of Vascular Surgery, Karolinska University Hospital Stockholm, Stockholm, Sweden
- Stockholm Aneurysm Research Group, STAR, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Rebecka Hultgren
- Department of Vascular Surgery, Karolinska University Hospital Stockholm, Stockholm, Sweden
- Stockholm Aneurysm Research Group, STAR, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
14
|
Kindon AJ, McCombie AM, Frampton C, Khashram M, Clarke G, Roake J. Early Relative Growth Rate of Abdominal Aortic Aneurysms and Future Risk of Rupture or Repair. Eur J Vasc Endovasc Surg 2023; 66:797-803. [PMID: 37567340 DOI: 10.1016/j.ejvs.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 07/27/2023] [Accepted: 08/04/2023] [Indexed: 08/13/2023]
Abstract
OBJECTIVE This study aimed to test whether the relative growth rate of subthreshold abdominal aortic aneurysms (AAAs) in the first 24 months of surveillance predicts the risk of future rupture or repair. METHODS This was a single centre retrospective observational analysis of all small (< 45 mm diameter) and medium (45 - 54 mm in men, 45 - 50 mm in women) AAAs entered into ultrasound surveillance between January 2002 and December 2019, which received ≥ 24 months of surveillance. Relative growth rates were calculated from measurements taken in the first 24 months of surveillance. The Kaplan-Meier method was used to estimate intervention and rupture free proportions five years following diagnosis for AAAs growing by < 5% and by ≥ 5% in the first 24 months of surveillance. Multivariable Cox regression analysis was used to further analyse this relationship by adjusting for factors found to be significantly associated with outcome in univariable analysis. RESULTS A total of 556 patients with AAAs (409 men, 147 women) were followed for ≥ 24 months. This included 431 small AAAs. Of these, 109 (25.3%) grew by < 5% in the first 24 months of surveillance and had a cumulative event free proportion of 0.98 ± 0.05 at five years compared with 0.78 ± 0.05 for the ≥ 5% growth group (p < .001). Of 125 medium AAAs, 26 (20.8%) grew by < 5% in the first 24 months of surveillance and had a cumulative event free proportion of 0.73 ± 0.11 at five years compared with 0.29 ± 0.13 for the ≥ 5% growth group (p = .024). Baseline diameter and early relative growth rate were strongly and independently predictive of future intervention or rupture with hazard ratios of 9.16 (95% CI 5.98 - 14.03, p < .001) and 4.46 (95% CI 2.45 - 8.14, p < .001), respectively. CONCLUSION The results suggest that slow expansion of small (< 45 mm) AAAs observed over an isolated 24 month period is indicative of a very low risk of rupture or repair in the medium term. Isolated growth rates may be a useful tool with which to triage low risk AAAs and prevent unnecessary surveillance.
Collapse
Affiliation(s)
- Andrew J Kindon
- Geo-Health Laboratory, University of Canterbury, New Zealand; Department of Radiology, Christchurch Public Hospital, Canterbury District Health Board, New Zealand; Christchurch Vascular Group, Christchurch, New Zealand.
| | | | | | - Manar Khashram
- Department of Surgery, University of Auckland, Auckland, New Zealand; Department of Vascular Surgery, Waikato Hospital, Hamilton, New Zealand
| | - Glynnis Clarke
- Department of Vascular, Endovascular & Transplant Surgery, Christchurch Public Hospital, Christchurch, New Zealand
| | - Justin Roake
- Christchurch Vascular Group, Christchurch, New Zealand; Department of Surgery, University of Otago, New Zealand; Department of Vascular, Endovascular & Transplant Surgery, Christchurch Public Hospital, Christchurch, New Zealand
| |
Collapse
|
15
|
Kim H, Kwon TW, Cho YP, Gwon JG, Han Y, Lee SA, Kim YJ, Kim S. Treatment Outcomes of Patients With Ruptured Abdominal Aortic Aneurysms. J Korean Med Sci 2023; 38:e321. [PMID: 37821088 PMCID: PMC10562185 DOI: 10.3346/jkms.2023.38.e321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 06/26/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Ruptured abdominal aortic aneurysm (rAAA) is a serious complication of abdominal aortic aneurysm associated with high operative mortality and morbidity rates. The present study evaluated the perioperative and long-term outcomes of Korean patients with rAAA based on national health insurance claims data. METHODS The National Health Insurance Service (NHIS) database was searched retrospectively to identify patients with rAAA who underwent endovascular aneurysm repair (EVAR) and open surgical repair (OSR) from 2009 to 2018. Perioperative (≤ 30 days), early postoperative (≤ 3 month), and long-term (> 3 month) survival, reinterventions, and complications were assessed. RESULTS The search identified 1,034 patients with rAAA, including 594 who underwent EVAR and 440 who underwent OSR. When the study period was divided into two, the total numbers of patients with rAAA, patients who underwent EVAR, and octogenarians were higher during the second half. The perioperative mortality rate was 29.8% in the EVAR and 35.0% in the OSR group (P = 0.028). Hartmann's procedure for bowel infarction was performed more frequently in the OSR than in the EVAR group (adjusted odds ratio, 6.28; 95% confidence interval [CI], 2.33-21.84; P = 0.001), but other complication rates did not differ significantly. All-cause mortality during the entire observation period did not differ significantly in the EVAR and OSR groups (adjusted hazard ratio, 1.17; 95% CI, 0.98-1.41; P = 0.087). Abdominal aortic aneurysm-related reintervention rate was significantly lower in the OSR group (adjusted hazard ratio, 0.31; 95% CI, 0.14-0.70; P = 0.005). CONCLUSION Although EVAR showed somewhat superior perioperative outcomes for rAAA, the long-term outcomes of EVAR after excluding initial 3 months were significantly worse than OSR. When anatomically feasible for both treatments, the perioperative mortality risk and reasonable prospects of long-term survival should be considered in rAAA.
Collapse
Affiliation(s)
- Hyangkyoung Kim
- Department of Surgery, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Tae-Won Kwon
- Division of Vascular Surgery, Department of Surgery, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, Korea.
| | - Yong-Pil Cho
- Division of Vascular Surgery, Department of Surgery, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, Korea
| | - Jun Gyo Gwon
- Division of Vascular Surgery, Department of Surgery, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, Korea
| | - Youngjin Han
- Division of Vascular Surgery, Department of Surgery, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, Korea
| | - Sang Ah Lee
- Division of Vascular Surgery, Department of Surgery, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, Korea
| | - Ye-Jee Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seonok Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
16
|
Ogino H, Iida O, Akutsu K, Chiba Y, Hayashi H, Ishibashi-Ueda H, Kaji S, Kato M, Komori K, Matsuda H, Minatoya K, Morisaki H, Ohki T, Saiki Y, Shigematsu K, Shiiya N, Shimizu H, Azuma N, Higami H, Ichihashi S, Iwahashi T, Kamiya K, Katsumata T, Kawaharada N, Kinoshita Y, Matsumoto T, Miyamoto S, Morisaki T, Morota T, Nanto K, Nishibe T, Okada K, Orihashi K, Tazaki J, Toma M, Tsukube T, Uchida K, Ueda T, Usui A, Yamanaka K, Yamauchi H, Yoshioka K, Kimura T, Miyata T, Okita Y, Ono M, Ueda Y. JCS/JSCVS/JATS/JSVS 2020 Guideline on Diagnosis and Treatment of Aortic Aneurysm and Aortic Dissection. Circ J 2023; 87:1410-1621. [PMID: 37661428 DOI: 10.1253/circj.cj-22-0794] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Affiliation(s)
- Hitoshi Ogino
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital
| | - Koichi Akutsu
- Cardiovascular Medicine, Nippon Medical School Hospital
| | - Yoshiro Chiba
- Department of Cardiology, Mito Saiseikai General Hospital
| | | | | | - Shuichiro Kaji
- Department of Cardiovascular Medicine, Kansai Electric Power Hospital
| | - Masaaki Kato
- Department of Cardiovascular Surgery, Morinomiya Hospital
| | - Kimihiro Komori
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine
| | - Hitoshi Matsuda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University
| | | | - Takao Ohki
- Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine
| | - Yoshikatsu Saiki
- Division of Cardiovascular Surgery, Graduate School of Medicine, Tohoku University
| | - Kunihiro Shigematsu
- Department of Vascular Surgery, International University of Health and Welfare Mita Hospital
| | - Norihiko Shiiya
- First Department of Surgery, Hamamatsu University School of Medicine
| | | | - Nobuyoshi Azuma
- Department of Vascular Surgery, Asahikawa Medical University
| | - Hirooki Higami
- Department of Cardiology, Japanese Red Cross Otsu Hospital
| | | | - Toru Iwahashi
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kentaro Kamiya
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Takahiro Katsumata
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College
| | - Nobuyoshi Kawaharada
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine
| | | | - Takuya Matsumoto
- Department of Vascular Surgery, International University of Health and Welfare
| | | | - Takayuki Morisaki
- Department of General Medicine, IMSUT Hospital, the Institute of Medical Science, the University of Tokyo
| | - Tetsuro Morota
- Department of Cardiovascular Surgery, Nippon Medical School Hospital
| | | | - Toshiya Nishibe
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kenji Okada
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | | | - Junichi Tazaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Masanao Toma
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center
| | - Takuro Tsukube
- Department of Cardiovascular Surgery, Japanese Red Cross Kobe Hospital
| | - Keiji Uchida
- Cardiovascular Center, Yokohama City University Medical Center
| | - Tatsuo Ueda
- Department of Radiology, Nippon Medical School
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine
| | - Kazuo Yamanaka
- Cardiovascular Center, Nara Prefecture General Medical Center
| | - Haruo Yamauchi
- Department of Cardiac Surgery, The University of Tokyo Hospital
| | | | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | | | - Yutaka Okita
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | - Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
| | | |
Collapse
|
17
|
Broeren M, Langenskiöld M, Pettersson ME. Psychosocial consequences after screening of abdominal aortic aneurysm among 65 year old men. JOURNAL OF VASCULAR NURSING 2023; 41:95-102. [PMID: 37684096 DOI: 10.1016/j.jvn.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 04/28/2023] [Accepted: 05/09/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND In order to reduce the incidence of abdominal aortic aneurysm rupture and mortality, the Swedish Medical Council has introduced a national abdominal aortic aneurysm (AAA) screening program that offers ultrasound examination of 65-year-old men. Screening programmes of AAA may confer both benefits and harms. The study aim was to investigate the psychosocial consequences of AAA screening among men with screening-detected AAA as compared to men identified as AAA-negative at screening, using an AAA-specific questionnaire. METHODS This cross-sectional study investigated the psychosocial consequences of AAA screening measured with a condition-specific questionnaire. This study focused on the Experience of the Diagnosis and the Screening Procedure in terms of Anxiety, Sense of Dejection and Existential Values. One hundred and fifty-eight men with AAA (63%) and 275 with normal aorta size (55%) completed the diagnosis-specific questionnaire. RESULTS Ninety-six percent of men with screening detected AAA did not regret the screening examination, the corresponding figure for controls being 99.6%. Seventy percent of AAA patients were surprised that something was wrong in their body. Some (85%) of men with AAA were current or previous smokers, about half of them (45%) felt guilty about it and 78% of the current smokers in the AAA group had considered stopping smoking. Both groups considered changing lifestyle, although at a higher rate (32%) among AAA cases than controls (20%), with differences both in intention to change their ways to exercise (p = 0.019) and food intake (p = 0.001). Intergroup differences were identified for the majority of items as captured by the questionnaire where men identified with AAA reported more negative psycho-social consequences for all evaluated items except for the items: Regret of the screening examination (p = 0.069) and feeling terrified (p = 0.10). Fifty-one percent of AAA cases stated that they feared rupture, and 12% were anxious about rupture during sexual activity whereas 57% were worried about rupture during intense physical activity. CONCLUSION Men who were diagnosed with AAA reported more psychosocial consequences compared to controls; still only a minority of AAA cases reported psychosocial consequences in greater occurrence. To some degree, men with AAA also feared rupture during various types of activities. There appears to be a need for improved patient information and easy access to caregivers for men with screening-detected AAA, which might help to reduce psychosocial consequences associated with the diagnosis.
Collapse
Affiliation(s)
- Monica Broeren
- Department of Vascular Surgery, Sahlgrenska University Hospital, SE-416 85 Gothenburg, Sweden.
| | - Marcus Langenskiöld
- Department of Vascular Surgery and Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital and Sahlgrenska Academy, University of Gothenburg, SE-416 85 Gothenburg, Sweden
| | - Monica E Pettersson
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg; Department of Vascular Surgery, Sahlgrenska University Hospital, SE-416 85 Gothenburg, Sweden
| |
Collapse
|
18
|
De Freitas S, D'Ambrosio N, Fatima J. Infrarenal Abdominal Aortic Aneurysm. Surg Clin North Am 2023; 103:595-614. [PMID: 37455027 DOI: 10.1016/j.suc.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Abdominal aortic aneurysms are found in up to 6% of men and 1.7% of women over the age of 65 years and are usually asymptomatic. The natural history of aortic aneurysms is continued dilation leading to rupture, which is associated with an overall 80% mortality. Of the patients with ruptured aneurysms that undergo intervention, half will not survive their hospitalization. Reduction in aneurysm mortality is therefore achieved by prophylactic repair during the asymptomatic period. On a population-based level, this is supported by abdominal aortic aneurysm screening programs. Approximately 60% of abdominal aortic aneurysms are confined to the infrarenal portion of the aorta and are amenable to repair with off-the-shelf endovascular devices. Endovascular techniques have now replaced open surgery as the primary modality for aneurysm repair.
Collapse
Affiliation(s)
- Simon De Freitas
- Department of Vascular Surgery, Georgetown University Hospital, MedStar Health, Washington, DC, USA
| | - Nicole D'Ambrosio
- Department of Vascular Surgery, Georgetown University Hospital, MedStar Health, Washington, DC, USA
| | - Javairiah Fatima
- Department of Vascular Surgery, Georgetown University Hospital, MedStar Health, Washington, DC, USA.
| |
Collapse
|
19
|
Dahl M, Lindholt J, Søgaard R, Refsgaard J, Svenstrup D, Moeslund NJ, Bredsgaard M, Høgh A. Relevance of the Viborg Population Based Screening Programme (VISP) for Cardiovascular Conditions Among 67 Year Olds: Attendance Rate, Prevalence, and Proportion of Initiated Cardiovascular Medicines Stratified By Sex. Eur J Vasc Endovasc Surg 2023; 66:119-129. [PMID: 36931553 DOI: 10.1016/j.ejvs.2023.03.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 02/08/2023] [Accepted: 03/10/2023] [Indexed: 03/17/2023]
Abstract
OBJECTIVE To report sex specific overall attendance rate, prevalence of screen detected cardiovascular conditions, proportion of unknown conditions before screening, and proportion initiating prophylactic medicine among 67 year olds in Denmark. DESIGN Cross sectional cohort study. METHODS Since 2014, all 67 year olds in Viborg, Denmark, have been invited to screening for abdominal aortic aneurysm (AAA), peripheral arterial disease (PAD), carotid plaque (CP), hypertension, cardiac disease, and type 2 diabetes. Individuals with AAA, PAD, and or CP are recommended cardiovascular prophylaxis. Combining data with registries has facilitated estimation of unknown screen detected conditions. Up to August 2019, 5 505 had been invited; registry data were available for the first 4 826 who were invited. RESULTS The attendance rate was 83.7%, without sex difference. Screen detected prevalence was significantly lower among women than men: AAA, 5 (0.3%) vs. 38 (1.9%) (p < .001); PAD, 90 (4.5%) vs. 134 (6.6%) (p = .011); CP, 641 (31.8%) vs. 907 (44.8%) (p < .001); arrhythmia, 26 (1.4%) vs. 77 (4.2%) (p < .001); blood pressure ≥ 160/100 mmHg, 277 (13.8%) vs. 346 (17.1%) (p = .004); and HbA1c ≥ 48 mmol/mol, 155 (7.7%) vs. 198 (9.8%) (p = .019), respectively. Pre-screening proportions of unknown conditions were particularly high for AAA (95.4%) and PAD (87.5%). AAA, PAD, and or CP were found in 1 623 (40.2%), of whom 470 (29.0%) received pre-screening antiplatelets and 743 (45.8%) lipid lowering therapy. Furthermore, 413 (25.5%) started antiplatelet therapy and 347 (21.4%) started lipid lowering therapy. Only smoking was significantly associated with all vascular conditions in multivariable analysis: odds ratios (ORs) for current smoking were AAA 8.11 (95% CI 2.27 - 28.97), PAD 5.60 (95% CI 3.61 - 8.67) and CP 3.64 (95% CI 2.95 - 4.47). CONCLUSION The attendance rate signals public acceptability for attending cardiovascular screening. Men had more screen detected conditions than women, but prophylactic medicine was started equally frequently in both sexes. Sex specific cost effectiveness follow up is warranted.
Collapse
Affiliation(s)
- Marie Dahl
- Vascular Research Unit, Department of Vascular Surgery, Viborg Regional Hospital, Viborg, Denmark; Department of Clinical Medicine, Aarhus University, Denmark; Research Unit of Cardiac, Thoracic, and Vascular Surgery, Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Denmark.
| | - Jes Lindholt
- Vascular Research Unit, Department of Vascular Surgery, Viborg Regional Hospital, Viborg, Denmark; Research Unit of Cardiac, Thoracic, and Vascular Surgery, Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Denmark; Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark; Elitary Research Centre CIMA, Odense University Hospital, Odense, Denmark
| | - Rikke Søgaard
- Department of Public Health, Aarhus University, Denmark; Department of Clinical Medicine, University of Southern Denmark, Denmark
| | - Jens Refsgaard
- Department of Cardiology, Viborg Regional Hospital, Viborg, Denmark
| | - Dorthe Svenstrup
- Department of Cardiology, Viborg Regional Hospital, Viborg, Denmark
| | | | | | - Annette Høgh
- Vascular Research Unit, Department of Vascular Surgery, Viborg Regional Hospital, Viborg, Denmark; Department of Clinical Medicine, Aarhus University, Denmark
| |
Collapse
|
20
|
Patel N, Dalmia VK, Carnevale M, Lipsitz E, Indes J. Identification and characterization of new candidates for abdominal aortic aneurysm screening in patients outside of current accepted guidelines. J Vasc Surg 2023; 78:89-95.e2. [PMID: 36893948 DOI: 10.1016/j.jvs.2023.02.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/21/2023] [Accepted: 02/25/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND Previous studies have identified groups of patients with abdominal aortic aneurysm (AAA) that fall outside of currently accepted screening guidelines. Population-based studies have found AAA screening would be cost-effective at a prevalence of 0.5% to 1.0%. The goal of this study was to determine the prevalence of AAA in patients that fall outside of the current screening guidelines. In addition, we analyzed outcomes of the groups with a prevalence of greater than 1%. METHODS Using the TriNetX Analytics Network, several patient cohorts were abstracted with a diagnosis of ruptured or unruptured AAA based on previously identified groups with a potentially high risk for AAA that fall outside of currently accepted screening guidelines. Groups were also stratified by sex. For groups found to have a prevalence of greater than 1%, the unruptured patients were further analyzed for long-term rates of rupture and included male ever-smokers aged 45 to 65, male never-smokers aged 65 to 75, male never-smokers aged greater than 75, and female ever-smokers aged 65 or greater. Long-term mortality, stroke, and myocardial infarction rates were compared in patients with treated and untreated AAA after propensity score matching. RESULTS We identified 148,279 patients across the four groups with a prevalence of AAA of greater than 1% with female ever-smokers aged 65 or older being the most prevalent (2.73%). In each of the four groups, the rate of AAA rupture increased every 5 years and all had rupture rates of greater than 1% at 10 years. Meanwhile, controls for each of these four subgroups without a previous AAA diagnosis had rupture rates between 0.090% and 0.013% at 10 years. Those who underwent repair of their AAA had decreased incidence of mortality, stroke, and myocardial infarction. Specifically, male ever-smokers aged 45 to 64 had a significant difference in incidence of mortality and myocardial infarction at 5 years and stroke at 1 and 5 years. CONCLUSIONS Our analysis suggests male ever-smokers aged 45 to 65, male never-smokers aged 65 to 75, male never-smokers aged greater than 75, and female ever-smokers aged 65 or greater have a more than 1% prevalence of AAA and, therefore, may benefit from screening. Outcomes were significantly worse compared with well-matched controls in these groups.
Collapse
Affiliation(s)
- Neil Patel
- Division of Vascular and Endovascular Surgery, Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | - Varun K Dalmia
- Section of Vascular Surgery, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Matthew Carnevale
- Division of Vascular and Endovascular Surgery, Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | - Evan Lipsitz
- Division of Vascular and Endovascular Surgery, Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | - Jeffrey Indes
- Division of Vascular and Endovascular Surgery, Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY.
| |
Collapse
|
21
|
Hornby-Foster I. Abdominal aortic aneurysm growth rates in patients undergoing local ultrasound surveillance. ULTRASOUND (LEEDS, ENGLAND) 2023; 31:23-32. [PMID: 36794114 PMCID: PMC9923150 DOI: 10.1177/1742271x221093751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 03/17/2022] [Indexed: 11/16/2022]
Abstract
Objectives Abdominal aortic aneurysm ultrasound surveillance varies between hospitals in the United Kingdom. University Hospitals Bristol and Weston adopt a 6-monthly surveillance interval for 4.5-4.9 cm abdominal aortic aneurysm, which is a deviation from nationally recommended 3-monthly intervals. Assessment of abdominal aortic aneurysm growth rate, and the concurrent impact of abdominal aortic aneurysm risk factors and medications prescribed for risk factors, may inform whether this change in surveillance intervals is safe and appropriate. Methods This analysis was conducted retrospectively. A total of 1312 abdominal aortic aneurysm ultrasound scans from 315 patients between January 2015 and March 2020 were split into 0.5 cm groups, ranging from 3.0 to 5.5 cm. Abdominal aortic aneurysm growth rate was assessed with one-way analysis of variance. The impact of risk factors and risk factor medication on abdominal aortic aneurysm growth rate was analysed using multivariate and univariate linear regression and Kruskal-Wallis tests. Patient cause of death among surveillance patients was recorded. Results Abdominal aortic aneurysm growth rate was significantly associated with increased abdominal aortic aneurysm diameter (p < 0.001). There was a significant whole-group reduction in growth rate from 0.29 to 0.19 cm/year in diabetics compared to non-diabetics (p = 0.02), supported by univariate linear regression (p = 0.04). In addition, gliclazide patients had lower growth rate compared to patients not on the medication (p = 0.04). One abdominal aortic aneurysm rupture occurred <5.5 cm resulting in death. Conclusion Abdominal aortic aneurysm measuring 4.5-4.9 cm had a mean growth rate of 0.3 cm/year (± 0.18 cm/year). Therefore, mean growth rate and variability suggest patients are unlikely to surpass surgical threshold of 5.5 cm between the 6-monthly surveillance scans, supported by low rupture rates. This suggests the surveillance interval for 4.5-4.9 cm abdominal aortic aneurysm is a safe and appropriate deviation from national guidance. In addition, it may be pertinent to consider diabetic status when designing surveillance intervals.
Collapse
Affiliation(s)
- Ian Hornby-Foster
- Vascular Science, University Hospitals Bristol and
Weston, Bristol, UK
| |
Collapse
|
22
|
Mota L, Marcaccio CL, Dansey KD, de Guerre LEVM, O'Donnell TFX, Soden PA, Zettervall SL, Schermerhorn ML. Overview of screening eligibility in patients undergoing ruptured AAA repair from 2003 to 2019 in the Vascular Quality Initiative. J Vasc Surg 2022; 75:884-892.e1. [PMID: 34695553 PMCID: PMC8863628 DOI: 10.1016/j.jvs.2021.09.049] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 09/21/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Although efforts such as the Screening Abdominal Aortic Aneurysms Very Efficiently (SAAAVE) Act have improved access to abdominal aortic aneurysm (AAA) screening, certain high-risk populations are currently excluded from the guidelines yet may benefit from screening. We therefore examined all patients who underwent repair of ruptured AAA (rAAA) to characterize those who are ineligible for screening under current guidelines and evaluate the potential impact of these restrictions on their disease. METHODS We identified patients undergoing rAAA repair in the Vascular Quality Initiative (VQI) database between 2003 and 2019. These patients were stratified by AAA screening eligibility according to the Centers for Medicare and Medicaid reimbursement guidelines. We then described baseline characteristics to identify high-risk features of these cohorts. Groups with disproportionate representation in the screening-ineligible cohort were identified as potential targets of screening expansion. Trends over time in screening eligibility and the proportion of AAA repairs performed for rAAA were also analyzed. RESULTS A total of 5340 patients underwent rAAA repair. The majority (66%) were screening-ineligible. When characterizing the screening-ineligible group by sex and risk factors (smoking history or family history of AAA), the largest contributors to screening ineligibility were males less than 65 years of age with a smoking history or family history of AAA (25%), males greater than 75 years of age with a smoking history (25%), and females older than 65 years of age with a smoking history (19%). In comparison with rAAAs prior to implementation of the SAAAVE act, the proportion of AAA repair performed for rupture among males undergoing AAA repair in the VQI decreased from 12% to 8% (P < .001), whereas in females, there was no change (P = .990). There was no statically significant difference in screening eligibility for either males (P = .762) or females (P = .335). CONCLUSIONS Most patients who underwent rAAA repair were ineligible for initial AAA screening or aged out of the screening window. Furthermore, rAAA rates and screening ineligibility have not improved as much as expected since the passage of the SAAAVE Act. Our data suggest that three high-risk populations may benefit from expansion of AAA screening guidelines: males with a smoking history or family history of AAA between ages 55 and 64 years, female smokers older than 65 years, and male smokers older than 75 years who are otherwise in good health. Increased efforts to screen these high-risk populations may increase elective AAA repair and minimize the morbidity and mortality associated with rAAAs.
Collapse
Affiliation(s)
- Lucas Mota
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Mass
| | - Christina L Marcaccio
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Mass
| | - Kirsten D Dansey
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Mass
| | - Livia E V M de Guerre
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Mass; Department of Vascular Surgery, University Medical Center, Utrecht, The Netherlands
| | - Thomas F X O'Donnell
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Mass
| | - Peter A Soden
- Division of Vascular Surgery, Department of Surgery, Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI
| | - Sara L Zettervall
- Division of Vascular Surgery, Department of Surgery, University of Washington, Seattle, Wash
| | - Marc L Schermerhorn
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Mass.
| |
Collapse
|
23
|
Louzada ACS, da Silva MFA, Portugal MFC, Stabellini N, Zerati AE, Amaro E, Teivelis MP, Wolosker N. Epidemiology of Abdominal Aortic Aneurysm Repair in Brazil from 2008 to 2019 and Comprehensive Review of Nationwide Statistics Across the World. World J Surg 2022; 46:1485-1492. [PMID: 35166878 DOI: 10.1007/s00268-022-06486-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2022] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Studying epidemiology of abdominal aortic aneurysms repairs is essential to prevent related deaths. Although outcomes are influenced by socioeconomic factors, there are no nationwide studies on these statistics in low-and-middle income countries. Therefore, we designed this study to evaluate abdominal aortic aneurysms repair rates, trends, costs, and in-hospital mortality in the Brazilian Public Health System, which exclusively insures over 160 million Brazilians. MATERIAL AND METHODS Retrospective cross-sectional population-based analysis of publicly available data referring to all abdominal aortic aneurysm repairs performed between 2008 and 2019 in Brazilian public hospitals. RESULTS We observed a total of 13,506 abdominal aortic aneurysm repairs, of which 32% were emergency endovascular repairs, 20% emergency open repairs, 32% elective endovascular repairs and 16% elective open repairs. There has been a downward trend in total abdominal aortic aneurysms repairs and an increasing predominance of endovascular repair. Elective and endovascular repairs were significantly associated with lower in-hospital mortality. For ruptured abdominal aortic aneurysms, we observed mortality rates of 13.8% after endovascular repair and 52.1% after open repair. For intact abdominal aortic aneurysms, we observed mortalities of 3.8% after endovascular repair and 18.6% after open repair. Procedure and mortality rates varied significantly among the Brazilian regions. CONCLUSIONS We observed a low and decreasing rate of abdominal aortic aneurysm repair. Most repairs were emergency and endovascular and there was an increasing predominance of endovascular repair. Endovascular and elective repairs were associated with lower mortality.
Collapse
Affiliation(s)
- Andressa Cristina Sposato Louzada
- Vascular and Endovascular Surgery Division, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, Bloco A1, sala 423 Morumbi, São Paulo, 05652-900, Brazil.
| | - Marcelo Fiorelli Alexandrino da Silva
- Vascular and Endovascular Surgery Division, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, Bloco A1, sala 423 Morumbi, São Paulo, 05652-900, Brazil
| | - Maria Fernanda Cassino Portugal
- Vascular and Endovascular Surgery Division, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, Bloco A1, sala 423 Morumbi, São Paulo, 05652-900, Brazil
| | - Nickolas Stabellini
- Faculdade Israelita de Ciências da Saúde Albert Einstein (FICSAE), Hospital Israelita Albert Einstein, Av. Prof. Francisco Morato, 4293, São Paulo, 05521-200, Brazil
| | - Antonio Eduardo Zerati
- Faculdade de Medicina da, Universidade de São Paulo (FMUSP), Av. Dr. Arnaldo, 455, São Paulo, 01246-903, Brazil
| | - Edson Amaro
- Vascular and Endovascular Surgery Division, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, Bloco A1, sala 423 Morumbi, São Paulo, 05652-900, Brazil.,Faculdade de Medicina da, Universidade de São Paulo (FMUSP), Av. Dr. Arnaldo, 455, São Paulo, 01246-903, Brazil
| | - Marcelo Passos Teivelis
- Vascular and Endovascular Surgery Division, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, Bloco A1, sala 423 Morumbi, São Paulo, 05652-900, Brazil.,Faculdade Israelita de Ciências da Saúde Albert Einstein (FICSAE), Hospital Israelita Albert Einstein, Av. Prof. Francisco Morato, 4293, São Paulo, 05521-200, Brazil
| | - Nelson Wolosker
- Vascular and Endovascular Surgery Division, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, Bloco A1, sala 423 Morumbi, São Paulo, 05652-900, Brazil.,Faculdade Israelita de Ciências da Saúde Albert Einstein (FICSAE), Hospital Israelita Albert Einstein, Av. Prof. Francisco Morato, 4293, São Paulo, 05521-200, Brazil.,Faculdade de Medicina da, Universidade de São Paulo (FMUSP), Av. Dr. Arnaldo, 455, São Paulo, 01246-903, Brazil
| |
Collapse
|
24
|
Kessler V, Klopf J, Eilenberg W, Neumayer C, Brostjan C. AAA Revisited: A Comprehensive Review of Risk Factors, Management, and Hallmarks of Pathogenesis. Biomedicines 2022; 10:94. [PMID: 35052774 PMCID: PMC8773452 DOI: 10.3390/biomedicines10010094] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 12/30/2021] [Indexed: 01/27/2023] Open
Abstract
Despite declining incidence and mortality rates in many countries, the abdominal aortic aneurysm (AAA) continues to represent a life-threatening cardiovascular condition with an overall prevalence of about 2-3% in the industrialized world. While the risk of AAA development is considerably higher for men of advanced age with a history of smoking, screening programs serve to detect the often asymptomatic condition and prevent aortic rupture with an associated death rate of up to 80%. This review summarizes the current knowledge on identified risk factors, the multifactorial process of pathogenesis, as well as the latest advances in medical treatment and surgical repair to provide a perspective for AAA management.
Collapse
Affiliation(s)
| | | | | | | | - Christine Brostjan
- Department of General Surgery, Division of Vascular Surgery, Medical University of Vienna, Vienna General Hospital, 1090 Vienna, Austria; (V.K.); (J.K.); (W.E.); (C.N.)
| |
Collapse
|
25
|
“Prevalence of Abdominal Aortic Aneurysms in four different metropolitan areas in Mexico”. Ann Vasc Surg 2022; 84:218-224. [DOI: 10.1016/j.avsg.2021.12.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 12/07/2021] [Accepted: 12/29/2021] [Indexed: 11/20/2022]
|
26
|
Kapila V, Jetty P, Wooster D, Vucemilo V, Dubois L. Screening for abdominal aortic aneurysms in Canada: 2020 review and position statement of the Canadian Society for Vascular Surgery. Can J Surg 2021; 64:E461-E466. [PMID: 34467750 PMCID: PMC8526155 DOI: 10.1503/cjs.009120] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Abdominal aortic aneurysms (AAAs) remain a major risk to patients, despite level 1 evidence for screening to prevent rupture events and decrease mortality. In 2007, the Canadian Society for Vascular Surgery (CSVS) published a review and position statement for AAA screening in Canada. Since that publication, there have been a number of updates in the published literature affecting screening recommendations. In this paper, we present a review of some of the controversies in the AAA screening literature to help elucidate differences in the various published screening guidelines. This article represents a review of the data and updated recommendations for AAA screening in the Canadian population on behalf of the CSVS. Les anévrismes de l’aorte abdominale (AAA) continuent de poser un risque majeur pour les patients, malgré des données probantes de niveau 1 à l’appui du dépistage pour prévenir les ruptures et réduire la mortalité. En 2007, la Société canadienne de chirurgie vasculaire (SCCV) a publié une revue et un énoncé de position sur le dépistage de l’AAA au Canada. Depuis lors, plusieurs mises à jour ont paru dans la littérature et elles ont un impact sur les recommandations relatives au dépistage. Dans le présent article, nous présentons une synthèse de quelques controverses soulevées dans la littérature sur le dépistage de l’AAA afin d’expliquer les différences entre les diverses lignes directrices publiées à ce sujet. Cet article propose au nom de la SCCV une revue des données probantes et des recommandations à jour sur le dépistage de l’AAA dans la population canadienne.
Collapse
Affiliation(s)
- Varun Kapila
- From the William Osler Health System, Brampton, Ont. (Kapila); the University of Ottawa, Ottawa, Ont. (Jetty); the University of Toronto, Toronto, Ont. (Wooster); Trillium Health Partners, Mississauga, Ont. (Vucemilo); and Western University, London, Ont. (Dubois)
| | - Prasad Jetty
- From the William Osler Health System, Brampton, Ont. (Kapila); the University of Ottawa, Ottawa, Ont. (Jetty); the University of Toronto, Toronto, Ont. (Wooster); Trillium Health Partners, Mississauga, Ont. (Vucemilo); and Western University, London, Ont. (Dubois)
| | - Doug Wooster
- From the William Osler Health System, Brampton, Ont. (Kapila); the University of Ottawa, Ottawa, Ont. (Jetty); the University of Toronto, Toronto, Ont. (Wooster); Trillium Health Partners, Mississauga, Ont. (Vucemilo); and Western University, London, Ont. (Dubois)
| | - Vic Vucemilo
- From the William Osler Health System, Brampton, Ont. (Kapila); the University of Ottawa, Ottawa, Ont. (Jetty); the University of Toronto, Toronto, Ont. (Wooster); Trillium Health Partners, Mississauga, Ont. (Vucemilo); and Western University, London, Ont. (Dubois)
| | - Luc Dubois
- From the William Osler Health System, Brampton, Ont. (Kapila); the University of Ottawa, Ottawa, Ont. (Jetty); the University of Toronto, Toronto, Ont. (Wooster); Trillium Health Partners, Mississauga, Ont. (Vucemilo); and Western University, London, Ont. (Dubois)
| | | |
Collapse
|
27
|
Duncan A, Maslen C, Gibson C, Hartshorne T, Farooqi A, Saratzis A, Bown MJ. Ultrasound screening for abdominal aortic aneurysm in high-risk women. Br J Surg 2021; 108:1192-1198. [PMID: 34370826 PMCID: PMC8545265 DOI: 10.1093/bjs/znab220] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 05/16/2021] [Indexed: 12/02/2022]
Abstract
Background Population-wide ultrasound screening programmes for abdominal aortic aneurysm (AAA) for men have already been established in some countries. Women account for one third of aneurysm-related mortality and are four times more likely to experience an AAA rupture than men. Whole-population screening for AAA in women is unlikely to be clinically or economically effective. The aim of this study was to determine the outcomes of a targeted AAA screening programme for women at high risk of AAA. Method Women aged 65–74 years deemed at high risk of having an AAA (current smokers, ex-smokers, or with a history of coronary artery disease) were invited to attend ultrasound screening (July 2016 to March 2019) for AAA in the Female Aneurysm screening STudy (FAST). Primary outcomes were attendance for screening and prevalence of AAA. Biometric data, medical history, quality of life (QoL) and aortic diameter on ultrasound imaging were recorded prospectively. Results Some 6037 women were invited and 5200 attended screening (86.7 per cent). Fifteen AAAs larger than 29 mm were detected (prevalence 0.29 (95 per cent c.i. 0.18 to 0.48) per cent). Current smokers had the highest prevalence (0.83 (95 per cent c.i. 0.34 to 1.89) per cent) but lowest attendance (75.2 per cent). Three AAAs greater than 5.5 cm were identified and referred for consideration of surgical repair; one woman underwent repair. There was a significant reduction in patient-reported QoL scores following screening. Conclusion A low prevalence of AAA was detected in high-risk women, with lowest screening uptake in those at highest risk. Screening for AAA in high-risk women may not be beneficial.
Collapse
Affiliation(s)
- A Duncan
- Department of Cardiovascular Sciences & National Institute for Health Research (NIHR) Leicester Biomedical Research Centre (BRC), University of Leicester, Glenfield Hospital, Leicester, UK.,Leicester Vascular Institute, Glenfield Hospital, Leicester, UK
| | - C Maslen
- Department of Cardiovascular Sciences & National Institute for Health Research (NIHR) Leicester Biomedical Research Centre (BRC), University of Leicester, Glenfield Hospital, Leicester, UK.,Leicester Vascular Institute, Glenfield Hospital, Leicester, UK
| | - C Gibson
- Department of Cardiovascular Sciences & National Institute for Health Research (NIHR) Leicester Biomedical Research Centre (BRC), University of Leicester, Glenfield Hospital, Leicester, UK
| | - T Hartshorne
- Leicester Vascular Institute, Glenfield Hospital, Leicester, UK
| | - A Farooqi
- Leicester City Clinical Commissioning Group, Leicester, UK
| | - A Saratzis
- Department of Cardiovascular Sciences & National Institute for Health Research (NIHR) Leicester Biomedical Research Centre (BRC), University of Leicester, Glenfield Hospital, Leicester, UK.,Leicester Vascular Institute, Glenfield Hospital, Leicester, UK
| | - M J Bown
- Department of Cardiovascular Sciences & National Institute for Health Research (NIHR) Leicester Biomedical Research Centre (BRC), University of Leicester, Glenfield Hospital, Leicester, UK.,Leicester Vascular Institute, Glenfield Hospital, Leicester, UK
| |
Collapse
|
28
|
Kim LG, Sweeting MJ, Armer M, Jacomelli J, Nasim A, Harrison SC. Modelling the impact of changes to abdominal aortic aneurysm screening and treatment services in England during the COVID-19 pandemic. PLoS One 2021; 16:e0253327. [PMID: 34129649 PMCID: PMC8205127 DOI: 10.1371/journal.pone.0253327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 06/02/2021] [Indexed: 12/01/2022] Open
Abstract
Background The National Health Service (NHS) abdominal aortic aneurysm (AAA) screening programme (NAAASP) in England screens 65-year-old men. The programme monitors those with an aneurysm, and early intervention for large aneurysms reduces ruptures and AAA-related mortality. AAA screening services have been disrupted following COVID-19 but it is not known how this may impact AAA-related mortality, or where efforts should be focussed as services resume. Methods We repurposed a previously validated discrete event simulation model to investigate the impact of COVID-19-related service disruption on key outcomes. This model was used to explore the impact of delayed invitation and reduced attendance in men invited to screening. Additionally, we investigated the impact of temporarily suspending scans, increasing the threshold for elective surgery to 7cm and increasing drop-out in the AAA cohort under surveillance, using data from NAAASP to inform the population. Findings Delaying invitation to primary screening up to two years had little impact on key outcomes whereas a 10% reduction in attendance could lead to a 2% lifetime increase in AAA-related deaths. In surveillance patients, a 1-year suspension of surveillance or increase in the elective threshold resulted in a 0.4% increase in excess AAA-related deaths (8% in those 5–5.4cm at the start). Longer suspensions or a doubling of drop-out from surveillance would have a pronounced impact on outcomes. Interpretation Efforts should be directed towards encouraging men to attend AAA screening service appointments post-COVID-19. Those with AAAs on surveillance should be prioritised as the screening programme resumes, as changes to these services beyond one year are likely to have a larger impact on surgical burden and AAA-related mortality.
Collapse
Affiliation(s)
- Lois G. Kim
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, Strangeways Research Laboratory, University of Cambridge, Cambridge, United Kingdom
- * E-mail:
| | - Michael J. Sweeting
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, Strangeways Research Laboratory, University of Cambridge, Cambridge, United Kingdom
- Department of Health Sciences, University of Leicester, George Davies Centre, Leicester, United Kingdom
| | - Morag Armer
- Public Health England, Wellington House, London, United Kingdom
| | - Jo Jacomelli
- Public Health England, Wellington House, London, United Kingdom
| | - Akhtar Nasim
- Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Sheffield, United Kingdom
| | - Seamus C. Harrison
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, Strangeways Research Laboratory, University of Cambridge, Cambridge, United Kingdom
| |
Collapse
|
29
|
Daroudi R, Shafe O, Moosavi J, Salimi J, Bayazidi Y, Zafarghandi MR, Maleki M, Moini M, Farshidmehr P, Sadeghipour P. Cost-effectiveness of a population-based AAA screening program for men over 65 years old in Iran. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2021; 19:29. [PMID: 33985531 PMCID: PMC8120703 DOI: 10.1186/s12962-021-00283-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 05/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Screening program tend to recognized patients in their early stage and consequently improve health outcomes. Cost-effectiveness of the abdominal aortic aneurysm (AAA) screening program has been scarcely studied in developing countries. We sought to evaluate the cost-effectiveness of a screening program for the abdominal aortic aneurysm (AAA) in men aged over 65 years in Iran. METHODS A Markov cohort model with 11 mutually exclusive health statuses was used to evaluate the cost-effectiveness of a population-based AAA screening program compared with a no-screening strategy. Transitions between the health statuses were simulated by using 3-month cycles. Data for disease transition probabilities and quality of life outcomes were obtained from published literature, and costs were calculated based on the price of medical services in Iran and the examination of the patients' medical records. The outcomes were life-years gained, the quality-adjusted life-year (QALY), costs, and the incremental cost-effectiveness ratio (ICER). The analysis was conducted for a lifetime horizon from the payer's perspective. Costs and effects were discounted at an annual rate of 3%. Uncertainty surrounding the model inputs was tested with deterministic and probabilistic sensitivity analyses. RESULTS The mean incremental cost of the AAA screening strategy compared with the no-screening strategy was $140 and the mean incremental QALY gain was 0.025 QALY, resulting in an ICER of $5566 ($14,656 PPP) per QALY gained. At a willingness-to-pay of 1 gross domestic product (GDP) per capita ($5628) per QALY gained, the probability of the cost-effectiveness of AAA screening was about 50%. However, at a willingness-to-pay of twice the GDP per capita per QALY gained, there was about a 95% probability for the AAA screening program to be cost-effective in Iran. CONCLUSIONS The results of this study showed that at a willingness-to-pay of 1 GDP per capita per QALY gained, a 1-time AAA screening program for men aged over 65 years could not be cost-effective. Nevertheless, at a willingness-to-pay of twice the GDP per capita per QALY gained, the AAA screening program could be cost-effective in Iran. Further, AAA screening in high-risk groups could be cost-effective at a willingness-to-pay of 1 GDP per capita per QALY gained.
Collapse
Affiliation(s)
- Rajabali Daroudi
- Department of Health Economics and Management, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Omid Shafe
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Vali-Asr Ave, 1995614331, Tehran, Iran
| | - Jamal Moosavi
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Vali-Asr Ave, 1995614331, Tehran, Iran
| | - Javad Salimi
- Vascular and Endovascular Department, Sina Hospital, Tehran University of Medical Science, Tehran, Iran
| | - Yahya Bayazidi
- Department of Pharmacoeconomics and Pharmaceutical Administration, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Zafarghandi
- Vascular and Endovascular Department, Sina Hospital, Tehran University of Medical Science, Tehran, Iran
| | - Majid Maleki
- Vascular and Endovascular Department, Sina Hospital, Tehran University of Medical Science, Tehran, Iran
| | - Majid Moini
- Vascular and Endovascular Department, Sina Hospital, Tehran University of Medical Science, Tehran, Iran
| | - Pezhman Farshidmehr
- Vascular and Endovascular Department, Sina Hospital, Tehran University of Medical Science, Tehran, Iran
| | - Parham Sadeghipour
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Vali-Asr Ave, 1995614331, Tehran, Iran.
| |
Collapse
|
30
|
Sidloff DA, Saratzis A, Thompson J, Katsogridakis E, Bown MJ. Editor's Choice - Infra-Renal Aortic Diameter and Cardiovascular Risk: Making Better Use of Abdominal Aortic Aneurysm Screening Outcomes. Eur J Vasc Endovasc Surg 2021; 62:38-45. [PMID: 33985908 DOI: 10.1016/j.ejvs.2021.03.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 03/09/2021] [Accepted: 03/13/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Aortic diameter (AD), used traditionally for abdominal aortic aneurysm (AAA) screening may have a role in assessing cardiovascular risk. Unfortunately, AD estimates for those without AAA are underutilised, whilst cardiovascular risk is sub-optimally managed in those with AAA. Our objective was to examine the association between AD measurements and future cardiovascular risk. METHODS Retrospective analysis of three databases of male participants screened for aortic aneurysm disease. Imaging and clinical data were obtained from three independent sources: 1) the Multi-centre Aneurysm Screening Study (MASS) trial (n = 26 882 men); 2) the 2013/14 cohort of the English NHS AAA Screening Programme (NAAASP) (n = 237 441 men) linked with NHS hospital admission and death registry data; and 3) the Framingham Heart Study (FHS) offspring cohort (n = 649). Associations between maximal aortic diameter, as measured on ultrasound or computed tomography, and cardiovascular outcomes were examined. RESULTS Cardiovascular mortality in the MASS trial, was higher in men with AAA at 13 years of follow up, compared to those without (Hazard Ratio [HR] 2.22, 95% CI 1.97-2.50, p < .001). Contemporary risk of major adverse cardiovascular events in the NAAASP was highest in those with an AAA (HR 2.91, 95% CI 2.00-4.25), whilst, extremes of aortic diameter were associated with increased risk for cardiovascular events. Aortic diameter was an independent risk factor for cardiovascular events in the FHS dataset. CONCLUSION Irrespective of the diagnosis of AAA, men attending for AAA screening who are found to have an abnormal aortic diameter are at high risk of future cardiovascular events. This currently unutilised data from AAA screening programmes has the potential to improve preventative management of cardiovascular risk.
Collapse
Affiliation(s)
- David A Sidloff
- Department of Cardiovascular Sciences and the NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, United Kingdom
| | - Athanasios Saratzis
- Department of Cardiovascular Sciences and the NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, United Kingdom
| | - John Thompson
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Emmanuel Katsogridakis
- Department of Cardiovascular Sciences and the NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, United Kingdom.
| | - Matt J Bown
- Department of Cardiovascular Sciences and the NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, United Kingdom
| |
Collapse
|
31
|
Sweeting MJ, Marshall J, Glover M, Nasim A, Bown MJ. Evaluating the Cost-Effectiveness of Changes to the Surveillance Intervals in the UK Abdominal Aortic Aneurysm Screening Programme. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:369-376. [PMID: 33641771 DOI: 10.1016/j.jval.2020.10.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 09/03/2020] [Accepted: 10/08/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To investigate the safety and cost-effectiveness of lengthening the time between surveillance ultrasound scans in the UK Abdominal Aortic Aneurysm (AAA) Screening Programme. METHODS A discrete event simulation model was used to evaluate the cost-effectiveness of AAA screening for men aged 65, comparing current surveillance intervals to 6 alternative surveillance interval strategies that lengthened the time between surveillance scans for 1 or more AAA size categories. The model considered clinical events and costs incurred over a 30-year time horizon and the cost per quality-adjusted life year (QALY). The model adopted the National Health Service perspective and discounted future costs and benefits at 3.5%. RESULTS Compared with current practice, alternative surveillance strategies resulted in up to a 4% reduction in the number of elective AAA repairs but with an increase of up to 1.6% in the number of AAA ruptures and AAA-related deaths. Alternative strategies resulted in a small reduction in QALYs compared to current practice but with reduced costs. Two strategies that lengthened surveillance intervals in only very small AAAs (3.0-3.9 cm) provided, at a cost-effectiveness threshold of £20 000 per QALY, the highest positive incremental net benefit. There was negligible chance that current practice is the most cost-effective strategy at any threshold below £40 000 per QALY. CONCLUSIONS Lengthening surveillance intervals in the UK Abdominal Aortic Aneurysm Screening Programme, especially for small AAA, can marginally reduce the incremental cost per QALY of the program. Nevertheless, whether the cost savings from refining surveillance strategies justifies a change in clinical practice is unclear.
Collapse
Affiliation(s)
- Michael J Sweeting
- Department of Health Sciences, University of Leicester, England, UK; MRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, England, UK.
| | - John Marshall
- UK National Screening Committee, London, England, UK
| | - Matthew Glover
- School of Biosciences and Medicine, University of Surrey, England, UK; Department of Clinical Sciences, Brunel University London, England, UK
| | - Akhtar Nasim
- Department of Vascular Surgery, University Hospitals of Leicester NHS Trust
| | - Matthew J Bown
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, England, UK
| |
Collapse
|
32
|
Rossi SH, Klatte T, Usher-Smith JA, Fife K, Welsh SJ, Dabestani S, Bex A, Nicol D, Nathan P, Stewart GD, Wilson ECF. A Decision Analysis Evaluating Screening for Kidney Cancer Using Focused Renal Ultrasound. Eur Urol Focus 2021; 7:407-419. [PMID: 31530498 DOI: 10.1016/j.euf.2019.09.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 08/19/2019] [Accepted: 09/03/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Screening for renal cell carcinoma (RCC) has been identified as a key research priority; however, no randomised control trials have been performed. Value of information analysis can determine whether further research on this topic is of value. OBJECTIVE To determine (1) whether current evidence suggests that screening is potentially cost-effective and, if so, (2) in which age/sex groups, (3) identify evidence gaps, and (4) estimate the value of further research to close those gaps. DESIGN, SETTING, AND PARTICIPANTS A decision model was developed evaluating screening in asymptomatic individuals in the UK. A National Health Service perspective was adopted. INTERVENTION A single focused renal ultrasound scan compared with standard of care (no screening). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Expected lifetime costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER), discounted at 3.5% per annum. RESULTS AND LIMITATIONS Given a prevalence of RCC of 0.34% (0.18-0.54%), screening 60-yr-old men resulted in an ICER of £18 092/QALY (€22 843/QALY). Given a prevalence of RCC of 0.16% (0.08-0.25%), screening 60-yr-old women resulted in an ICER of £37327/QALY (€47 129/QALY). In the one-way sensitivity analysis, the ICER was <£30000/QALY as long as the prevalence of RCC was ≥0.25% for men and ≥0.2% for women at age 60yr. Given the willingness to pay a threshold of £30000/QALY (€37 878/QALY), the population-expected values of perfect information were £194 million (€244 million) and £97 million (€123 million) for 60-yr-old men and women, respectively. The expected value of perfect parameter information suggests that the prevalence of RCC and stage shift associated with screening are key research priorities. CONCLUSIONS Current evidence suggests that one-off screening of 60-yr-old men is potentially cost-effective and that further research into this topic would be of value to society. PATIENT SUMMARY Economic modelling suggests that screening 60-yr-old men for kidney cancer using ultrasound may be a good use of resources and that further research on this topic should be performed.
Collapse
Affiliation(s)
- Sabrina H Rossi
- Department of Surgery, University of Cambridge, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK; Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK; Cancer Research UK Cambridge Centre, University of Cambridge, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK
| | - Tobias Klatte
- Department of Surgery, University of Cambridge, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK; Department of Urology, Royal Bournemouth Hospital, Bournemouth, UK
| | - Juliet A Usher-Smith
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Kate Fife
- Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK; Cancer Research UK Cambridge Centre, University of Cambridge, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK
| | - Sarah J Welsh
- Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK
| | - Saeed Dabestani
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Lund, Sweden
| | - Axel Bex
- The Royal Free London NHS Foundation Trust, Specialist Centre for Kidney Cancer, UK; Netherlands Cancer Institute, Division of Surgical Oncology, Department of Urology, Amsterdam, The Netherlands
| | - David Nicol
- Department of Urology, Royal Marsden Hospital, London, UK; Institute of Cancer Research, London, UK
| | - Paul Nathan
- Department of Oncology, Mount Vernon Cancer Centre, Northwood, UK
| | - Grant D Stewart
- Department of Surgery, University of Cambridge, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK; Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK; Cancer Research UK Cambridge Centre, University of Cambridge, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK.
| | - Edward C F Wilson
- Cambridge Centre for Health Services Research, University of Cambridge Institute of Public Health, Forvie Site, Robinson Way, Cambridge, UK; Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, UK.
| |
Collapse
|
33
|
Bains P, Oliffe JL, Mackay MH, Kelly MT. Screening Older Adult Men for Abdominal Aortic Aneurysm: A Scoping Review. Am J Mens Health 2021; 15:15579883211001204. [PMID: 33724072 PMCID: PMC7970195 DOI: 10.1177/15579883211001204] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 01/28/2021] [Accepted: 02/10/2021] [Indexed: 11/25/2022] Open
Abstract
Abdominal aortic aneurysm (AAA) is a potentially fatal condition predominantly affecting older adult men (60 years or over). Based on evidence, preventative health-care guidelines recommend screening older males for AAA using ultrasound. In attempts to reduce AAA mortality among men, screening has been utilized for early detection in some Western countries including the UK and Sweden. The current scoping review includes 19 empirical studies focusing on AAA screening in men. The findings from these studies highlight benefits and potential harms of male AAA screening. The benefits of AAA screening for men include decreased incidence of AAA rupture, decreased AAA mortality, increased effectiveness of elective AAA repair surgery, and cost-effectiveness. The potential harms of AAA screening included lack of AAA mortality reduction, negative impacts on quality of life, and inconsistent screening eligibility criteria being applied by primary care practitioners. The current scoping review findings are discussed to suggest changes to AAA screening guidelines and improve policy and practice.
Collapse
Affiliation(s)
- Priya Bains
- School of Nursing, University of
British Columbia, Vancouver, BC, Canada
| | - John L. Oliffe
- School of Nursing, University of
British Columbia, Vancouver, BC, Canada
- Department of Nursing, University
of Melbourne, Melbourne, VIC, Australia
| | - Martha H. Mackay
- School of Nursing, University of
British Columbia, Vancouver, BC, Canada
- Centre for Health Evaluation and
Outcomes Sciences, Vancouver, BC, Canada
| | - Mary T. Kelly
- School of Nursing, University of
British Columbia, Vancouver, BC, Canada
| |
Collapse
|
34
|
Abstract
Abdominal aortic aneurysm (AAA) disease remains a major source of morbidity in developed countries and can progress to life-threatening rupture if left untreated, with exceedingly high mortality. The goal of AAA management is to identify and electively repair AAAs before rupture. AAA disease burden and outcomes have improved over time with declining tobacco use and advancements in care across patients' disease course. The introduction of endovascular AAA repair, in particular, has allowed for elective AAA repair in patients previously considered too high risk for open surgery and has contributed to lower rates of AAA rupture over time. However, these improved outcomes are not universally experienced, and disparities continue to exist in the detection, treatment, and outcomes of AAA by sex, race, and ethnicity. Mitigating these disparities requires enhanced, focused efforts at preventing disease, promoting health, and delivering appropriate care among an increasingly diverse patient population.
Collapse
Affiliation(s)
- Christina L Marcaccio
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, 110 Francis Street, Suite 5B, Boston, MA 02215
| | - Marc L Schermerhorn
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, 110 Francis Street, Suite 5B, Boston, MA 02215.
| |
Collapse
|
35
|
Fite J, Gayarre-Aguado R, Puig T, Zamora S, Escudero JR, Solà Roca J, Bellmunt-Montoya S. Feasibility and Efficiency Study of a Population-Based Abdominal Aortic Aneurysm Screening Program in Men and Women in Spain. Ann Vasc Surg 2020; 73:429-437. [PMID: 33387620 DOI: 10.1016/j.avsg.2020.11.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 11/04/2020] [Accepted: 11/26/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND Based on current evidence, one-time screening for abdominal aortic aneurysm (AAA) in men using ultrasound evaluation reduces mortality related to AAA rupture and is considered cost-effective, although all-cause mortality reduction still remains in question. In Spain, there is no population screening program for AAA, so the aim of our study was to perform a pilot population screening program in our area to assess feasibility and efficiency of an AAA screening program for men and women. METHODS A population AAA screening pilot program was performed in a Barcelona area, including 400,000 inhabitants. According to inclusion criteria, 4,730 individuals aged 65 years at the moment of the trial were invited for screening (2,089 men and 2,641 women). Primary care doctors, trained in duplex ultrasound abdominal evaluations, performed an abdominal aortic measurement. Individuals with a previous diagnosis of AAA, limited life expectancy, or wrong contact data were excluded. Participation data, aortic diameters, AAA prevalence, and related cardiovascular risk factors were analyzed. The results were used in a cost-utility model to assess the efficiency of the screening program. RESULTS Participation was 50.3% in men and 44% in women. Eleven patients were excluded because of previously diagnosed AAA. Five new asymptomatic AAA were detected in 65-year-old men (0.5% prevalence), all being active smokers. When considering patients excluded for previous AAA diagnosis, the prevalence in 65-year-old men reached 1.4%. Global AAA prevalence in smoking men reached 2.67%. No AAA was detected in women. Subaneurysmal aorta prevalence in men was 2.9% (n = 29), and in women, it was 0.08% (n = 2). A cost-utility analysis model on screening versus no screening retrieved 13,664€ per quality-adjusted life years at a 10-year horizon and 39,455€ per quality-adjusted life years at a 30-year horizon. CONCLUSIONS AAA population-based screening by ultrasound evaluation in primary care is logistically feasible in our area. Despite that, AAA prevalence is lower than expected in men, and null in women. Cost-utility model results indicate that a local AAA screening program is only efficient in a 30 years' time horizon. Such inefficient results for a population screening make it necessary to consider other strategies such as opportunistic or subgroup screening in our area.
Collapse
Affiliation(s)
- Joan Fite
- Vascular Surgery Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Vascular Biology and Inflammation Laboratory, CIBER Cardiovascular, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Teresa Puig
- Universitat Autònoma de Barcelona, Barcelona, Spain; Epidemiology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, CIBER Cardiovascular, Biomedical Research Institute Sant Pau, Barcelona, Spain.
| | - Silvia Zamora
- General Practitioner in Primary Care Team EAP Dreta Eixample, Barcelona, Spain
| | - Jose Roman Escudero
- Vascular Surgery Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Vascular Biology and Inflammation Laboratory, CIBER Cardiovascular, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Judit Solà Roca
- Universitat Autònoma de Barcelona, Barcelona, Spain; Epidemiology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, CIBER Cardiovascular, Biomedical Research Institute Sant Pau, Barcelona, Spain
| | - Sergi Bellmunt-Montoya
- Universitat Autònoma de Barcelona, Barcelona, Spain; Vascular Surgery Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Institut de Recerca Vall Hebron, Barcelona, Spain
| |
Collapse
|
36
|
FitÉ J, Gimenez E, Soto B, Artigas V, Escudero JR, Bellmunt-Montoya S, Espallargues M. Systematic review on abdominal aortic aneurysm screening cost-efficiency and methodological quality assessment. INT ANGIOL 2020; 40:67-76. [PMID: 33086780 DOI: 10.23736/s0392-9590.20.04547-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Abdominal aortic aneurysm (AAA) is a silent, progressive disease that can lead to death. It is easily diagnosed with noninvasive methods and its routine treatment has excellent results. This creates an optimal situation for population screening programs. The aim of this paper was to assess results and methodological quality of cost-utility studies on screening versus no screening scenarios for AAA to assess future establishment of new AAA screening programs. EVIDENCE ACQUISITON A systematic review of efficiency (cost-effectiveness and cost-utility) studies was performed, finally selecting cost-utility studies on AAA screening versus no screening. Papers were selected that dealt with efficiency of screening for AAA according to PICOTS framework and the methodological quality assessed according to the economic evaluation analyses described by Drummond and Caro. Two independent reviewers were involved in the procedure. EVIDENCE SYNTHESIS Research retrieved 88 studies. From those, 26 showed cost-effectiveness and cost-utility results. Finally, 10 studies had cost-utility results and suited criteria (published in the last 10 years; time-horizon: 10 years or more) for exhaustive analysis. All publications, except one, showed adequate incremental cost-utility ratios according to different national perspectives. Methodological assessment showed some quality limitations, but the majority of items analyzed were favorably answered after applying the questionnaires. CONCLUSIONS Confirmation of the cost-utility results in this revision at a national/regional level should be the basis for the implantation of new national screening programs worldwide. The methodological evaluation applied in this revision is crucial for the corresponding future piggy-back trials to assess routine application of national AAA screening programs.
Collapse
Affiliation(s)
- Joan FitÉ
- Centro de Investigación Biomédica en Red (CIBER) Cardiovascular, Department of Vascular Surgery, Hospital de la Santa Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain.,Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Emmanuel Gimenez
- Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Generalitat de Catalunya, Barcelona, Spain
| | - Begoña Soto
- Centro de Investigación Biomédica en Red (CIBER) Cardiovascular, Department of Vascular Surgery, Hospital de la Santa Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain.,Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Vicente Artigas
- Centro de Investigación Biomédica en Red (CIBER) Cardiovascular, Department of Vascular Surgery, Hospital de la Santa Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain.,Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Jose R Escudero
- Centro de Investigación Biomédica en Red (CIBER) Cardiovascular, Department of Vascular Surgery, Hospital de la Santa Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain.,Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Sergi Bellmunt-Montoya
- Universitat Autónoma de Barcelona, Barcelona, Spain - .,Department of Vascular Surgery, Hospital Universitari Vall d'Hebron, University of Barcelona, Barcelona, Spain
| | - Mireia Espallargues
- Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Generalitat de Catalunya, Barcelona, Spain.,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Barcelona, Spain
| |
Collapse
|
37
|
de Boer AR, Vaartjes I, van Dis I, van Herwaarden JA, Nathoe HM, Ruigrok YM, Bots ML, Visseren FLJ. Screening for abdominal aortic aneurysm in patients with clinically manifest vascular disease. Eur J Prev Cardiol 2020; 29:1170-1176. [PMID: 33624031 DOI: 10.1093/eurjpc/zwaa014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/13/2020] [Accepted: 07/28/2020] [Indexed: 11/12/2022]
Abstract
AIMS Declining prevalence of abdominal aortic aneurysm (AAA) might force a more targeted screening approach (high-risk populations only) in order to maintain (cost-)effectiveness. We aimed to determine temporal changes in the prevalence of screening-detected AAA, to assess AAA-related surgery, and evaluate all-cause mortality in patients with manifest vascular disease. METHODS AND RESULTS We included patients with manifest vascular disease but without a history of AAA enrolled in the ongoing single-centre prospective UCC-SMART cohort study. Patients were screened at baseline for AAA by abdominal ultrasonography. We calculated sex- and age-specific prevalence of AAA, probability of survival in relation to the presence of AAA, and the proportion of patients undergoing AAA-related surgery. Prevalence of screening-detected AAA in 5440 screened men was 2.5% [95% confidence interval (CI) 2.1-2.9%] and in 1983 screened women 0.7% (95% CI 0.4-1.1%). Prevalence declined from 1997 until 2017 in men aged 70-79 years from 8.1% to 3.2% and in men aged 60-69 years from 5.7% to 1.0%. 36% of patients with screening-detected AAA received elective AAA-related surgery during follow-up (median time until surgery = 5.3 years, interquartile range 2.5-9.1). Patients with screening-detected AAA had a lower probability of survival (sex and age adjusted) compared to patients without screening-detected AAA (51%, 95% CI 41-64% vs. 69%, 95% CI 68-71%) after 15 years of follow-up. CONCLUSION The prevalence of screening-detected AAA has declined over the period 1997-2017 in men with vascular disease but exceeds prevalence in already established screening programs targeting 65-year-old men. Screening for AAA in patients with vascular disease may be cost-effective, but this remains to be determined.
Collapse
Affiliation(s)
- Annemarijn R de Boer
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.,Dutch Heart Foundation, The Hague, the Netherlands
| | - Ilonca Vaartjes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.,Dutch Heart Foundation, The Hague, the Netherlands
| | | | - Joost A van Herwaarden
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Hendrik M Nathoe
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Ynte M Ruigrok
- Department of Neurology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Frank L J Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands
| |
Collapse
|
38
|
Fattahi N, Rosenblad A, Kragsterman B, Hultgren R. Risk factors in 50-year-old men predicting development of abdominal aortic aneurysm. J Vasc Surg 2020; 72:1337-1346.e1. [DOI: 10.1016/j.jvs.2019.11.062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 11/21/2019] [Indexed: 11/30/2022]
|
39
|
Hellawell HN, Mostafa AMHAM, Kyriacou H, Sumal AS, Boyle JR. Abdominal aortic aneurysms part one: Epidemiology, presentation and preoperative considerations. J Perioper Pract 2020; 31:274-280. [PMID: 32981453 PMCID: PMC8258725 DOI: 10.1177/1750458920954014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
An abdominal aortic aneurysm is an irreversible dilatation of the abdominal aorta. The majority of abdominal aortic aneurysms are asymptomatic and identified incidentally while investigating a separate pathology. Others are detected by national screening programmes and some present due to a growth or rupture. Symptomatic or ruptured aneurysms require urgent or emergency repair in patients fit for surgery. Perioperative practitioners should therefore be aware of how patients with abdominal aortic aneurysms present and are investigated, so that they can implement timely management. Guidelines have been recently updated to reflect this. This literature review discusses these recommendations and explores the evidence upon which they are based. The aim of this article is to highlight the important preoperative principles that need to be considered in cases of abdominal aortic aneurysm.
Collapse
Affiliation(s)
- Holly N Hellawell
- University of Cambridge, School of Clinical Medicine, Addenbrookes Hospital, Cambridge, UK
| | - Ahmed M H A M Mostafa
- University of Cambridge, School of Clinical Medicine, Addenbrookes Hospital, Cambridge, UK
| | - Harry Kyriacou
- University of Cambridge, School of Clinical Medicine, Addenbrookes Hospital, Cambridge, UK
| | - Anoop S Sumal
- University of Cambridge, School of Clinical Medicine, Addenbrookes Hospital, Cambridge, UK
| | - Jonathan R Boyle
- Cambridge University Hospitals, NHS Foundation Trust, Cambridge Vascular Unit, Cambridge, UK
| |
Collapse
|
40
|
Reile R, Võrno T, Kals J, Ilves P, Kiivet RA. The Cost-Effectiveness of Abdominal Aortic Aneurysm Screening in Estonia. Value Health Reg Issues 2020; 22:1-6. [DOI: 10.1016/j.vhri.2019.08.477] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 08/21/2019] [Accepted: 08/31/2019] [Indexed: 10/25/2022]
|
41
|
Reutersberg B, Salvermoser M, Haller B, Schäffer C, Knipfer E, Laugwitz KL, Eckstein HH. Screening cardiovascular patients for aortic aneurysms (SCAN) - high prevalence of abdominal aortic aneurysms in coronary heart disease patients requiring intervention. VASA 2020; 49:375-381. [PMID: 32631140 DOI: 10.1024/0301-1526/a000881] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background: Since the prevalence of abdominal aortic aneurysms (AAA) in Europe has declined to about 2.5%, general screening programs of elderly men are being called into question. On the other hand, other vascular diseases (e.g. coronary heart disease, CHD) are associated with a higher prevalence of AAA. This might have an impact on future targeted AAA screening programs. This study aimed to reevaluate the current prevalence of AAA in male patients with CHD, in order to assess whether CHD patients should be offered a targeted AAA ultrasound screening program. Patients and methods: The SCAN (Screening Cardiovascular Patients for Aortic Aneurysms) study prospectively evaluated the AAA prevalence in 1000 consecutive male CHD patients (70.1 ± 11.2 years) requiring any coronary intervention at an university hospital. All patients received transverse and longitudinal ultrasound scans of the abdominal aorta. Aortic diameter was assessed using the outer-to-outer measurement-technique. Primary endpoint was the prevalence of AAA. Secondary outcomes included stratification in 1-, 2-, or 3-vessel CHD. Results: AAA was detected in 85 patients (median diameter 38 mm, range 30-80 mm), corresponding to an overall prevalence of 8.5%. AAA prevalence was significantly associated with CHD severity: 5.6% in 1-vessel, 7.1% in 2-vessel, and 10.8% in 3-vessel CHD (P = 0.037). The multivariable analysis showed, that age per 10 years increase (OR 1.5, 95% CI 1.2-1.9, P = 0.001) and hyperlipidemia (OR 2.2, 95% CI 1.3-3.8, P = 0.003) were significantly associated with an AAA. The likelihood to be diagnosed with an AAA was significantly lower in non-smokers (OR 0.24, 95% CI, P < 0.001). Conclusions: This study confirms that CHD requiring any type of coronary intervention is strongly associated with AAA in male patients. AAA prevalence increases with CHD severity. Since the AAA prevalence is still significantly higher than in the general population, targeted ultrasound screening should be considered for all CHD patients.
Collapse
Affiliation(s)
- Benedikt Reutersberg
- Munich Aortic Center (MAC), Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Michael Salvermoser
- Munich Aortic Center (MAC), Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Bernhard Haller
- Institute of Medical Informatics, Statistics and Epidemiology, Technical University of Munich, Munich, Germany
| | - Christoph Schäffer
- Munich Aortic Center (MAC), Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Eva Knipfer
- Munich Aortic Center (MAC), Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Karl-Ludwig Laugwitz
- Department of Cardiology, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Hans-Henning Eckstein
- Munich Aortic Center (MAC), Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| |
Collapse
|
42
|
Saw ST, Leong BDK, Abdul Aziz DA. Early Detection of Undiagnosed Abdominal Aortic Aneurysm and Sub-Aneurysmal Aortic Dilatations in Patients with High-Risk Coronary Artery Disease: The Value of Targetted Screening Programme. Vasc Health Risk Manag 2020; 16:215-229. [PMID: 32606718 PMCID: PMC7293413 DOI: 10.2147/vhrm.s250735] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 05/26/2020] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Abdominal aortic aneurysm (AAA) and coronary artery disease (CAD) share common risk factors. The objective of this study was to determine the prevalence of undiagnosed AAA in patients with angiographically diagnosed significant CAD. PATIENTS AND METHODS Male patients aged 50 years and above (including indigenous people) with angiographically diagnosed significant CAD in the recent one year were screened for AAA. Standard definition of abdominal aortic aneurysm and CAD was used. All new patients were followed up for six months for AAA events (ruptured AAA and AAA-related mortality). RESULTS A total of 277 male patients were recruited into this study. The total prevalence of undiagnosed AAA in this study population was 1.1% (95% CI 0.2-3.1). In patients with high-risk CAD, the prevalence of undiagnosed AAA was 1.7% (95% CI 0.3-4.8). The detected aneurysms ranged in size from 35.0mm to 63.8mm. Obesity was a common factor in these patients. There were no AAA-related mortality or morbidity during the follow-up. Although the total prevalence of undiagnosed AAA is low in the studied population, the prevalence of sub-aneurysmal aortic dilatation in patients with significant CAD was high at 6.6% (95% CI 3.9-10.2), in which majority were within the younger age group than 65 years old. CONCLUSION This was the first study on the prevalence of undiagnosed AAA in a significant CAD population involving indigenous people in the island of Borneo. Targeted screening of patients with high-risk CAD even though they are younger than 65 years old effectively discover potentially harmful asymptomatic AAA and sub-aneurysmal aortic dilatations.
Collapse
Affiliation(s)
- Siong Teng Saw
- Faculty of Medicine, Universiti Kebangsaan Malaysia; Hospital Queen Elizabeth II, Kota Kinabalu, Sabah88300, Malaysia
| | | | - Dayang Anita Abdul Aziz
- Faculty of Medicine, Universiti Kebangsaan Malaysia, UKM Medical Center, Kuala Lumpur56000, Malaysia
| |
Collapse
|
43
|
Mwipatayi BP, Oshin OA, Faraj J, Varcoe RL, Wong J, Becquemin JP, Riambau V, Böckler D, Verhagen HJ. Analysis of Midterm Outcomes of Endovascular Aneurysm Repair in Octogenarians From the ENGAGE Registry. J Endovasc Ther 2020; 27:836-844. [PMID: 32436808 DOI: 10.1177/1526602820923827] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To assess periprocedural results and secondary endovascular procedure outcomes over 5 years in patients aged ≥80 vs <80 years undergoing endovascular aneurysm repair (EVAR). MATERIALS AND METHODS Data from the Endurant Stent Graft Natural Selection Global post-market registry (ENGAGE) were used for the analyses. A total of 1263 consecutive patients were enrolled in the prospective, observational, single-arm registry and divided into 2 groups according to age: ≥80 years (290, 22.9%) and <80 years (973, 77.1%). Baseline patient characteristics, risk scores according to the Society for Vascular Surgery (SVS) reporting standards, American Society of Anesthesiologists (ASA) classification, quality of life assessments [EuroQol 5 (EQ5D) index], and treatment outcomes, including all-cause mortality, aneurysm-related mortality, major adverse events, secondary endovascular procedures, and endoleaks were compared between groups. RESULTS Octogenarians were classified into the highest category of the SVS risk stratification system; however, this did not result in a significant difference in the 30-day mortality [1.4% (4/290) vs 1.2% (12/973) for controls; p=0.85] or major adverse event rates [5.2% (15/290) vs 3.6% (35/973), p=0.23]. Multivariable analysis confirmed that age ≥80 years, pulmonary disease, large aneurysm diameter, and renal insufficiency were significantly associated with all-cause mortality, whereas diameter was the only parameter associated with increased aneurysm-related mortality. The differences in freedom from secondary endovascular procedures over 5 years between octogenarians and controls did not reach statistical significance (88.5% vs 83.2%, p=0.07). CONCLUSION EVAR can be performed in individuals aged ≥80 years with no statistically significant difference in midterm aneurysm-related deaths compared with younger patients. The findings in this elderly patient cohort show that EVAR can be safely performed with acceptable morbidity rates in octogenarians.
Collapse
Affiliation(s)
- Bibombe P Mwipatayi
- Department of Vascular Surgery, Royal Perth Hospital, Perth, Western Australia, Australia.,School of Surgery, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Olufemi A Oshin
- Department of Vascular Surgery, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Joseph Faraj
- Department of Vascular Surgery, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Ramon L Varcoe
- Department of Surgery, Prince of Wales Hospital and the University of New South Wales, Sydney, Australia
| | - Jackie Wong
- Department of Vascular Surgery, Royal Perth Hospital, Perth, Western Australia, Australia
| | | | - Vincente Riambau
- Division of Vascular Surgery, Thorax Institute, Hospital Clinic, University of Barcelona, Spain
| | - Dittmar Böckler
- Division of Vascular Surgery, University Hospital Heidelberg, Germany
| | - Hence J Verhagen
- Division of Vascular and Endovascular Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| |
Collapse
|
44
|
Vänni V, Turtiainen J, Kaustio U, Toivanen J, Rusanen M, Hernesniemi J. Prospective Ultrasound Screening of Men With Cerebrovascular Disease for Abdominal Aortic Aneurysms. Scand J Surg 2020; 110:395-399. [PMID: 32380927 DOI: 10.1177/1457496920917269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The prevalence of abdominal aortic aneurysms is higher in population with other vascular comorbidities, especially among men. Utility of screening among patients with cerebrovascular disease is unclear. OBJECTIVE To determine the prevalence of abdominal aortic aneurysm in male patients with diagnosed cerebrovascular disease manifested by transient ischemic attack or stroke. METHODS Between May 2013 and May 2014, all consecutive male patients undergoing carotid ultrasound in single tertiary center with a catchment area of 179,000 inhabitants were evaluated for ultrasound screening of abdominal aortic aneurysm. Abdominal aortic aneurysm was defined as maximum diameter of infrarenal aorta 30 mm or more. RESULTS Of 105 (n = 105) consecutively evaluated male patients, only 69% (n = 72) were eligible for the study and underwent aortic screening. Reason for ineligibility was most often poor general medical condition (n = 29). Mean age of screened patients was 66 years (SD 9.8 years). Half of the screened patients suffered stroke (n = 36). The incidence of abdominal aortic aneurysm was 5.6% (n = 4). All found abdominal aortic aneurysms were small and did not require immediate surgical intervention. During a follow-up period of over 4 years, none of the aneurysms exhibited tendency for growth. CONCLUSIONS The male population with cerebrovascular disease is comorbid and frail. Only, moderate prevalence of abdominal aortic aneurysms can be found in this subpopulation.
Collapse
Affiliation(s)
- Ville Vänni
- Department of Surgery, North Karelia Central Hospital, Tikkamäentie 16, Joensuu, 80210, Finland
| | - Johanna Turtiainen
- Department of Surgery, North Karelia Central Hospital, Joensuu, Finland.,Department of Neurology, North Karelia Central Hospital, Joensuu, Finland
| | - Ulla Kaustio
- Department of Neurology, Central Finland Central Hospital, Jyväskylä, Finland
| | - Jari Toivanen
- Department of Surgery, North Karelia Central Hospital, Joensuu, Finland.,Department of Neurology, North Karelia Central Hospital, Joensuu, Finland
| | - Minna Rusanen
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Public Health Promotion Unit, Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland
| | | |
Collapse
|
45
|
Hultgren R, Elfström KM, Öhman D, Linné A. Long-Term Follow-Up of Men Invited to Participate in a Population-Based Abdominal Aortic Aneurysm Screening Program. Angiology 2020; 71:641-649. [PMID: 32351123 DOI: 10.1177/0003319720921741] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A screening program for abdominal aortic aneurysm (AAA), inviting 65-year-old men, was started in Stockholm in 2010 (2.3 million inhabitants). The aim was to present a long-term follow-up of men participating in screening, as well as AAA repair and ruptures among nonparticipants. Demographics were collected for men with screening detected with AAA 2010 to 2016 (n = 672) and a control group with normal aortas at screening (controls, n = 237). Medical charts and regional Swedvasc (Swedish Vascular registry) data were analyzed for aortic repair for men born 1945 to 1951. Ultrasound maximum aortic diameter (AD) as well as Aortic Size Index (ASI) was recorded. Participation was 78% and prevalence of AAA was 1.2% (n = 672). Aortic repair rates correlated with high ASI and AD. During the study period, 22% of the AAA patients were treated with the elective repair; 35 men in surveillance died (5.2%), non-AAA-related causes (82.9%) dominated, followed by unknown causes among 4 (11.4%), and 2 (5.7%) possibly AAA-related deaths. Abdominal aortic aneurysm rupture rate was higher among nonparticipants (0.096% vs 0.0036%, P < .001). The low dropout rate confirms acceptability of follow-up after screening. The efficacy is shown by the much higher rupture rate among the nonparticipating men.
Collapse
Affiliation(s)
- Rebecka Hultgren
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden
| | | | - Daniel Öhman
- Regional Cancer Center Stockholm-Gotland, Stockholm, Sweden
| | - Anneli Linné
- Department of Clinical Science and Education, Karolinska Institutet at Södersjukhuset, Stockholm, Sweden.,Department of Surgery, Section of Vascular Surgery, Södersjukhuset, Stockholm, Sweden
| |
Collapse
|
46
|
Nationwide Analysis of Ruptured Abdominal Aortic Aneurysm in Portugal (2000-2015). Eur J Vasc Endovasc Surg 2020; 60:27-35. [PMID: 32307303 DOI: 10.1016/j.ejvs.2020.02.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 02/05/2020] [Accepted: 02/28/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Ruptured abdominal aortic aneurysm (rAAA) is a lethal condition that requires acute repair to prevent death. This analysis aims to assess the nationwide trends in rAAA admission, repair and mortality in a country, Portugal, without national screening for AAA. METHODS rAAA registered in the hospital administrative database of the National Health Service and all nationally registered deaths due to rAAA based on death certificate data were analysed. Three time periods (2000-2004, 2005-2009, and 2010-2015) were compared in patients ≥ 50 years old to assess the variations over time. RESULTS A total of 2 275 patients ≥50 years old with rAAA were identified in the two databases from 2000 to 2015. The age standardised incidence of rAAA was 2.78 ± 0.24/100 000/year in 2000-2004, 3.17 ± 0.39/100 000/year in 2005-2009 and 3.21 ± 0.28/100 000/year in 2010-2015 (p < .001). When comparing the time periods 2000-2004 to 2005-2009, the age standardised rate of admission (n = 1460) increased from 1.57 ± 0.25/100 000/year to 2.24 ± 0.32/100 000/year (p < .001). The operative mortality rates decreased during this time period (from 55.3 ± 4.7% to 48.8 ± 4.7%, p < .001). In 2010-2015, the age standardised rate of admissions due to rAAA decreased (1.98 ± 0.22/100 000/year). Operative mortality remained stable (48.9 ± 6.2%). The rate of patient deaths outside the hospital decreased from the first to the second period (1.21 ± 0.10/100 000/year and 0.93 ± 0.29/100 000/year, respectively) but later increased (1.14 ± 0.22/100 000/year). This resulted in a higher overall rAAA related mortality in Portugal in the third period (2.20 ± 0.18/100 000/year, 2.21 ± 0.27/100 000/year and 2.26 ± 0.26/100 000/year in 2000-2004, 2005-2009, and 2010-2015, respectively, p < .001). CONCLUSION Overall, the incidence of rAAA in Portugal has been stable over the past 10 years. The rates of admission, repair, and death due to rAAA repair seem to have reached an inflection point and are now decreasing. Mortality outside the hospital remains a matter of concern, warranting further planning of streamlined transfer networks and vascular surgical departments.
Collapse
|
47
|
Summers KL, Kerut EK, Sheahan CM, Sheahan MG. Evaluating the prevalence of abdominal aortic aneurysms in the United States through a national screening database. J Vasc Surg 2020; 73:61-68. [PMID: 32330595 DOI: 10.1016/j.jvs.2020.03.046] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 03/20/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The U.S. Preventative Services Task Force guidelines for abdominal aortic aneurysm (AAA) screening are based mainly on studies of older Caucasian males from non-U.S. POPULATIONS This study was designed to analyze the findings of a large, all-inclusive AAA screening program in the United States. METHODS Screening events were held nationally by a U.S. nonprofit organization between 2001 and 2017. AAA screening was offered regardless of risk profile. Participants filled out a demographics form with known comorbidities. Significant risk factors were determined using logistic regression with backward stepwise variable selection. Odds ratios (OR) are reported with 95% confidence intervals (CIs). RESULTS A total of 9457 screened participants (47% male) were analyzed. The mean age was 67 ± 9 years with 40.8% between 65 and 75 years old. Most participants were Caucasian (83.4%), followed by African American (13.1%). Screened risk factors included hypertension (58.1%), hyperlipidemia (54.9%), smoking (52.0%), cardiac disease (29.2%), diabetes mellitus (18.4%), a family history of AAA (22.4%) or brain aneurysms (8.6%), and body mass index (26.9 ± 5.28). Overall, 267 participants (2.82%) were found to have an AAA (>3 cm). Those ages 65 to 75 had a prevalence of 2.98%. In a fully adjusted, multivariate logistic regression, there was an increased risk of AAA in males (OR, 3.24; 95% CI, 2.39-4.40), current smokers (OR, 3.28; 95% CI, 2.36-4.54), previous smokers (OR, 1.86; 95% CI, 1.41-2.47), cardiac disease (OR, 1.30; 95% CI, 1.01-1.68), family history of AAA (OR, 1.60; 95% CI, 1.20-2.14), and advancing age (P < .0001). Female ever smokers 65 to 75 years old had a prevalence of 1.7%. Male smokers 45 to 54 and 55 to 64 years old had a prevalence of 3.37% and 4.43%, respectively. There was an increased risk of AAA in females with morbid obesity (OR, 5.54; 95% CI, 1.34-22.83 in never smokers and OR, 5.61; 95% CI, 1.04-30.15 in smokers), female smokers with hypertension (OR, 3.22; 95% CI, 1.21-8.58), males with cardiac disease (OR, 2.06; 95% CI, 1.08-3.90 in never smokers and OR, 1.48; 95% CI, 1.05-2.09), male smokers with a family history of AAA (OR, 1.69; 95% CI, 1.61-2.46), and current smokers (OR, 6.33; 95% CI, 2.62-15.24 for females and OR, 2.50; 95% CI, 1.70-3.65 for males). CONCLUSIONS This study shows that there remain high-risk groups outside the current guidelines that would likely benefit from AAA screening. Risk factors for AAA include male gender, smoking, cardiac disease, family history of AAA, and advancing age. The most significant risk factor is current smoking status.
Collapse
Affiliation(s)
- Kelli L Summers
- Division of Vascular Surgery, Department of Surgery, Louisiana State University Medical Center, New Orleans, La.
| | - Edmund K Kerut
- Division of Cardiovascular Diseases, Department of Medicine, Louisiana State University Medical Center, New Orleans, La
| | - Claudie M Sheahan
- Division of Vascular Surgery, Department of Surgery, Louisiana State University Medical Center, New Orleans, La
| | - Malachi G Sheahan
- Division of Vascular Surgery, Department of Surgery, Louisiana State University Medical Center, New Orleans, La
| |
Collapse
|
48
|
Chan WC, Papaconstantinou D, Winnard D, Jackson G. Retrospective review of abdominal aortic aneurysm deaths in New Zealand: what proportion of deaths is potentially preventable by a screening programme in the contemporary setting? BMJ Open 2019; 9:e027291. [PMID: 31366645 PMCID: PMC6677995 DOI: 10.1136/bmjopen-2018-027291] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES To describe the proportions of people dying from abdominal aortic aneurysm (AAA) who might have benefited from a formal screening programme for AAA. DESIGN Retrospective cross-sectional review of deaths. SETTING AND STUDY POPULATIONS All AAA deaths registered in New Zealand from 2010 to 2014 in the absence of a national AAA screening programme. MAIN OUTCOME MEASURES Known history of AAA prior to the acute event leading to AAA death, prognosis limiting comorbidities, history of prior abdominal imaging and a validated multimorbidity measure (M3-index scores). RESULTS 1094 AAA deaths were registered in the 5 years between 2010 and 2014 in New Zealand. Prior to the acute AAA event resulting in death, 31.3% of the cohort had a known AAA diagnosis, and 10.9% had a previous AAA procedure. On average, the AAA diagnosis was known 3.7 years prior to death. At least 77% of the people dying from AAA also had one or more other prognosis limiting diagnosis. The hazard of 1-year mortality associated with the non-AAA related comorbidities for the AAA cohort aged 65 or above were 1.5-2.6 times higher than to the age matched general population based on M3-index scores. In 2014, overall AAA deaths accounted for only 0.7% of total deaths, and 1.0% of deaths among men aged 65 or above in New Zealand. At most, 20% of people dying from AAA in New Zealand between 2010 and 2014 might have had the potential to derive full benefit from a screening programme. About 51% of cases would have derived no or very limited benefit from a screening programme. CONCLUSION Falling AAA mortality, and high prevalence of competing comorbidities and/or prior AAA diagnosis and procedure raises the question about the likely value of a national AAA screening programme in a country such as New Zealand.
Collapse
Affiliation(s)
- Wing Cheuk Chan
- Population Health, Counties Manukau District Health Board, Auckland, New Zealand
| | | | - Doone Winnard
- Population Health, Counties Manukau District Health Board, Auckland, New Zealand
| | - Gary Jackson
- Population Health, Counties Manukau District Health Board, Auckland, New Zealand
| |
Collapse
|
49
|
Nicolini F, Vezzani A, Corradi F, Gherli R, Benassi F, Manca T, Gherli T. Gender differences in outcomes after aortic aneurysm surgery should foster further research to improve screening and prevention programmes. Eur J Prev Cardiol 2019; 25:32-41. [PMID: 29708035 DOI: 10.1177/2047487318759121] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Background Gender-related biases in outcomes after thoracic aortic surgery are an important factor to consider in the prevention of potential complications related to aortic diseases and in the analysis of surgical results. Methods The aim of this study is to provide an up-to-date review of gender-related differences in the epidemiology, specific risk factors, outcome, and screening and prevention programmes in aortic aneurysms. Results Female patients affected by aortic disease still have worse outcomes and higher early and late mortality than men. It is difficult to plan new specific strategies to improve outcomes in women undergoing major aortic surgery, given that the true explanations for their poorer outcomes are as yet not clearly identified. Some authors recommend further investigation of hormonal or molecular explanations for the sex differences in aortic disease. Others stress the need for quality improvement projects to quantify the preoperative risk in high-risk populations using non-invasive tests such as cardiopulmonary exercise testing. Conclusions The treatment of patients classified as high risk could thus be optimised before surgery becomes necessary by means of numerous strategies, such as the administration of high-dose statin therapy, antiplatelet treatment, optimal control of hypertension, lifestyle improvement with smoking cessation, weight loss and careful control of diabetes. Future efforts are needed to understand better the gender differences in the diagnosis, management and outcome of aortic aneurysm disease, and for appropriate and modern management of female patients.
Collapse
Affiliation(s)
| | - Antonella Vezzani
- 2 General and Specialistic Surgery Department, Azienda Ospedaliero Universitaria di Parma, Italy
| | - Francesco Corradi
- 3 Anaesthesia and Intensive Care Unit, E.O. Ospedali Galliera, Italy
| | - Riccardo Gherli
- 4 Department of Cardiovascular Sciences, San Camillo Forlanini Hospital, Italy
| | - Filippo Benassi
- 2 General and Specialistic Surgery Department, Azienda Ospedaliero Universitaria di Parma, Italy
| | - Tullio Manca
- 2 General and Specialistic Surgery Department, Azienda Ospedaliero Universitaria di Parma, Italy
| | - Tiziano Gherli
- 1 Department of Medicine and Surgery, University of Parma, Italy
| |
Collapse
|
50
|
Nair N, Kvizhinadze G, Jones GT, Rush R, Khashram M, Roake J, Blakely A. Health gains, costs and cost-effectiveness of a population-based screening programme for abdominal aortic aneurysms. Br J Surg 2019; 106:1043-1054. [PMID: 31115915 DOI: 10.1002/bjs.11169] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 12/24/2018] [Accepted: 02/12/2019] [Indexed: 01/29/2023]
Abstract
BACKGROUND Abdominal aortic aneurysm (AAA) rupture carries a high fatality rate. AAAs can be detected before rupture by abdominal ultrasound imaging, allowing elective repair. Population-based screening for AAA in older men reduces AAA-related mortality by about 40 per cent. The UK began an AAA screening programme offering one-off scans to men aged 65 years in 2009. Sweden has a similar programme. Currently, there is no AAA screening programme in New Zealand. This cost-utility analysis aimed to assess the cost-effectiveness of a UK-style screening programme in the New Zealand setting. METHODS The analysis compared a formal AAA screening programme (one-off abdominal ultrasound imaging for about 20 000 men aged 65 years in 2011) with no systematic screening. A Markov macrosimulation model was adapted to estimate the health gains (in quality-adjusted life-years, QALYs), health system costs and cost-effectiveness in New Zealand. A health system perspective and lifetime horizon was adopted. RESULTS With New Zealand-specific inputs, the adapted model produced an estimate of about NZ $15 300 (€7746) per QALY gained, with a 95 per cent uncertainty interval (UI) of NZ $8700 to 31 000 (€4405 to 15 694) per QALY gained. Health gains were estimated at 117 (95 per cent UI 53 to 212) QALYs. Health system costs were NZ $1·68 million (€850 535), with a 95 per cent UI of NZ $820 200 to 3·24 million (€415 243 to €1·65 million). CONCLUSION Using New Zealand's gross domestic product per capita (about NZ $45 000 or €22 100) as a cost-effectiveness threshold, a UK-style AAA screening programme would be cost-effective in New Zealand.
Collapse
Affiliation(s)
- N Nair
- Burden of Disease Epidemiology, Equity and Cost-Effectiveness Programme (BODE3), Department of Public Health, University of Otago, Wellington, New Zealand
| | - G Kvizhinadze
- Burden of Disease Epidemiology, Equity and Cost-Effectiveness Programme (BODE3), Department of Public Health, University of Otago, Wellington, New Zealand
| | - G T Jones
- Vascular Research Group, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - R Rush
- Waitemata District Health Board, University of Auckland, Auckland, New Zealand
| | - M Khashram
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - J Roake
- Department of Surgery, University of Otago, Christchurch, New Zealand
| | - A Blakely
- Burden of Disease Epidemiology, Equity and Cost-Effectiveness Programme (BODE3), Department of Public Health, University of Otago, Wellington, New Zealand
| |
Collapse
|